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NDT Advance Access published online on November 30, 2004
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfh605
© 2004 by European Renal Association - European Dialysis and Transplant Association
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Received February 20, 2004
Accepted October 22, 2004

Original Articles

Transplanting kidneys from CMV-seropositive donors to CMV-seronegative recipients is not associated with poorer renal allograft function or survival

Kevin McLaughlin 1*, Sabrina Sandhu 1, Caren Wu 1, Norman Muirhead 2, David Hollomby 2, and Anthony Jevnikar 2

1 Department of Medicine, University of Calgary, Alberta, Canada
2 Division of Nephrology, Department of Internal Medicine, London Health Science Centre and University of Western Ontario, London, Ontario, Canada

* To whom correspondence should be addressed.
Kevin McLaughlin, E-mail: kevin.mclaughlin{at}calgaryhealthregion.ca



  Abstract

Background. Cytomegalovirus (CMV)-seronegative recipients of renal allografts from CMV-seropositive donors (D+/R-) have a higher rate of acute rejection than other renal transplant recipients. A relationship between CMV infection/disease and chronic allograft nephropathy (CAN) has been proposed from animal studies, although human studies have been inconclusive. The objective of this study was to determine if CMV seromatching has an effect on renal allograft function and allograft survival.

Methods. A retrospective single centre study was carried out in 333 first cadaveric transplant recipients from January 1, 1991 to December 31, 1997. The primary end-point was creatinine clearance at 3 years post-transplant in groups based on CMV seromatching. The secondary end-point was renal allograft survival.

Results. Mean creatinine clearance 3 years post-transplant was 53.4 ml/min/1.73 m2 of body surface area. There was no significant difference in the mean creatinine clearance for groups formed on the basis of CMV seromatching. Delayed graft function and acute rejection were associated with a lower creatinine clearance at 3 years and reduced overall graft survival [hazard ratios 2.35 (1.56-3.54) (P<0.001) and 1.57 (1.0-2.46) (P = 0.046), respectively]. Considering the end-point of graft loss due to acute rejection (censoring for death with a functioning graft) identified the D+/R- group as having an increased hazard of graft loss due to acute rejection [hazard ratio 3.12 (1.16-8.57) (P = 0.024)].

Conclusions. The D+/R- group does not appear to have poorer renal allograft function 3 years post-transplant. This group does, however, have an increased risk of early allograft loss due to acute rejection.

Keywords: chronic allograft nephropathy; creatinine clearance; cytomegalovirus; renal transplantation.
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