Age matters: older age as a risk factor for CMV reactivation in the CMV serostatus-positive kidney transplant recipient

Eur J Clin Microbiol Infect Dis. 2020 Mar;39(3):455-463. doi: 10.1007/s10096-019-03744-3. Epub 2019 Nov 22.


Evaluate risk factors for cytomegalovirus (CMV) reactivation during the first year after kidney transplantation in the CMV-seropositive older recipient. Retrospective single-center study. Between 2011 and 2015, 91 patients ≥ 65 years received a kidney transplant; these were matched with 91 controls, aged 40-60. Risk of CMV reactivation in the CMV-seropositive recipients was analyzed. Sixty-three older and 54 younger recipients were included; 50% had received CMV-directed prophylaxis. CMV reactivation was significantly more frequent in the older group (71.4% vs 44.4%, p = 0.003) and occurred earlier (p = 0.003). A multivariate model showed that only age was associated with CMV reactivation (OR 2.48, p = 0.03). After excluding patients that received thymoglobulin, older age group remained the only risk factor of CMV reactivation (OR 3.81, p = 0.014). Recurrent event analysis showed that the older cohort had an HR of 1.94 (p = 0.01) of CMV viremia; there was significant episode-cohort interaction (p < 0.01). While the older group had a higher risk of infection (HR = 2.43), after the initial episode the relative hazards were approximately equal (HR = 1.08, at period 2). This suggests that it is key to specifically avoid the first episode of reactivation. Universal prophylaxis or a hybrid prophylaxis model should be considered in the CMV-seropositive kidney transplant recipient aged ≥ 65 years.

Keywords: Cytomegalovirus; Infection; Kidney transplantation; Older adults.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Comorbidity
  • Cytomegalovirus / classification
  • Cytomegalovirus / physiology*
  • Cytomegalovirus Infections / diagnosis
  • Cytomegalovirus Infections / epidemiology*
  • Cytomegalovirus Infections / mortality
  • Cytomegalovirus Infections / virology*
  • Disease Management
  • Female
  • Humans
  • Kidney Transplantation / adverse effects
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Prognosis
  • Serogroup
  • Viremia
  • Virus Activation*