COVID-19 Infection May Lead to Increased CMV Infection in Renal Transplant Recipients

Abstract

Background: The COVID-19 pandemic has caused significant mortality and morbidity, especially in renal transplant recipients. The mortality and hospitalization rate of COVID-19 infected transplant recipients is much higher than in the healthy population. Although progress has been made in the management of COVID-19 in renal transplant recipients, there are still unexplained clinical differences among patients. We think that cytomegalovirus (CMV) infection may also play a role in this clinical difference in COVID-19 infected transplant recipients. For this purpose, we aimed to screen for the presence of CMV viremia or infection in kidney transplant patient groups who were and were not diagnosed with COVID-19 in the last year.

Method: We included 191 consecutive kidney transplant recipients followed in our transplant clinic. The patients were divided into two groups according to whether they had COVID-19 infection or not in the last 1 year. CMV DNA levels were tested in the whole patients' groups. We compared CMV positivity rates in patients with and without COVID-19.

Results: There were 83 patients who had COVID-19 and 108 patients who did not. Whereas CMV viremia was detected in 15 transplant recipients with COVID-19 infection, CMV viremia was detected in 4 patients who did not have COVID-19 (P = .001, logistic regression = 4.8, 95% confidence interval [CI] = 1328-17,103; Figure 1).There was no difference in terms of immunosuppressive therapy, steroid use, duration, and type of transplantation. The COVID-19 negative and positive groups were similar in lymphocyte and leukocyte counts (Table 1). In the multivariate analysis, CMV positivity was found to be positively associated with COVID-19 infection but lymphocyte count and estimated glomerular filtration rate (eGFR) were found to be independently and negatively correlated.

Conclusions: CMV infection may accompany COVID-19 or may occur in the post-COVID-19 period. It can cause increased morbidity and mortality. Routine screening and early treatment for CMV may reduce mortality in high-risk group.