NDT Advance Access originally published online on March 10, 2008
Nephrology Dialysis Transplantation 2008 23(8):2673-2678; doi:10.1093/ndt/gfn111
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HLA-DQ3 is a probable risk factor for CMV infection in high-risk kidney transplant patients
1 Transplantation and Surgical Clinic, Semmelweis University, Budapest, Hungary 2 Immunogenetic Department, National Medical Centre, Budapest, Hungary 3 Department of Endocrinology, Barts and the London Medical School, London, UK
Correspondence and offprint requests to: Marina Varga, Transplantation and Surgical Clinic, Semmelweis University, Baross Street 23-25, Budapest 1082, Hungary. E-mail: marisa1{at}freemail.hu
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Abstract |
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Background. Cytomegalovirus (CMV) infection in transplant patients with special risk factors remains a major hazard. CMV-seronegative recipients with seropositive donors have the highest risk of developing acute CMV disease. We suggest that the HLA-type may influence the occurrence and the severity of primary CMV infection of these recipients and the measurement of the special HLA-types may be useful in the prediction of acute infection.
Methods. Since 1999 1213 cadaver kidney transplantations have been performed in our clinic. 163 of 1213 recipients were CMV-seronegative (13%) and 129 of them received the kidney from seropositive donors. All 129 patients received CMV infection prophylaxis. Of 129 CMV-seronegative patients 49 developed acute CMV infection (38%) during the first posttransplant year. CMV infection was diagnosed by CMV antigenemia test and serologic measurements (ELISA). The particular HLA-genotypes of the recipients were studied before the transplantation. The occurrence and the severity of CMV infection was investigated in association with HLA-types.
Results. We found different acute CMV infection distribution in the careers and non-careers of investigated HLA-types: HLA-A2, HLA-B12, HLA-Cw7, HLA-DR6 and HLA-DR11, but the differences weren't significant in these HLA-types (P = 0.26, P = 0.37, P = 0.83, P = 0.07 and P = 0.37). While investigating HLA-DQ3, we found that of 68 DQ3-positive patients 32 (47%), of 61 DQ3-negative patients 17 (28%) had acute CMV infection and this difference was found to be significant. This result was confirmed by univariate and multivariate Cox Regression (P = 0.001) and the appropriate significance level was considered by Bonferroni correction.
Conclusions. HLA-DQ3 was found to be an independent predictor of CMV infection. Our data suggest that patients positive for HLA-DQ3 are more susceptible to CMV infection than a comparable group of patients negative for HLA-DQ3. This result was not due to rejection and/or treatment for rejection and wasn't influenced by induction therapy. Although we found more symptomatic infections among DQ3+ patients the difference wasn't significant (P = 0.19). Comparing the gender proportion among all 1213 kidney recipients and among CMV-seronegative recipients we found that the proportion of males is significantly higher among CMV-seronegative recipients (P < 0.001).
Keywords: cytomegalovirus; HLA; kidney transplantation; prophylaxis; risk factors
Received for publication: 1. 6.07
Accepted in revised form: 7. 2.08