655. Early and Severe Human Cytomegalovirus DNA Viremia Associates With Progressive Loss of Renal Function
Session: Poster Abstract Session: Oh, Those Pesky Viruses!
Thursday, October 27, 2016
Room: Poster Hall
Background:

Human cytomegalovirus (HCMV) is the most common viral infection after renal transplantation and is associated with decreased late graft and patient survival, despite application of antiviral medication. Reducing immunosuppression permits clearance of the virus but simultaneously induces a risk for acute rejection. The aim of this study was to assess the effects of early HCMV DNA viremia on transplant rejection and renal function.

Methods:

264 (age 50.9±13.5; male 55%) Renal transplantation recipients receiving preemptive antiviral therapy were retrospectively categorized based on whole blood HCMV peak viral load (PVL) in the first 3 months post-transplantation; PVL≤100, PVL101-2000 or PVL>2000 copies/ml. The association between PVL and rejection was analyzed with Kaplan-Meier survival analysis. Renal function, using estimated Glomerular Filtration Rate (eGFR) after 3 till 36 months, was analyzed with multivariable linear regression and a Linear Mixed-Effects Model.

Results:

HCMV viremia was detectable in 114 (43%) recipients within 49 [38-67] days. T-cell mediated rejection-free survival was significantly lower for the PVL-high group, compared to the low group (KM; P=0.019). Additionally, non-infected (PVL≤100) and mildly-infected recipients (PVL101-2000) demonstrated statistically significant better renal function at 3, 6, 12, 24 and 36 months (KW; P<0.05 for all). Subjects with severe HCMV infection (PVL>2000) had 5-10 ml/min lower eGFR between 3 and 36 months, remaining after adjustment for recipient, donor and transplantation characteristics (MLR; P<0.05 at 3, 6, 12, 24 and 36 months). Severely infected subjects demonstrated an annual 1.8 mL/min/1.73m2 faster eGFR decrease (LME; P=0.009).

Conclusion:

Severe HCMV viremia early after renal transplantation is associated with pronounced loss of renal function on the intermediate and long-term, and a faster eGFR annual decline. This loss was irreversible, so that recipients do not recover from this initial hit even three years post-transplantation. It is important to consider that not the infection in itself, but the extent of HCMV viremia affects renal function. Preventing the early peak in HCMV viral load from exceeding the threshold of 2000 copies/ml, presumably through new antiviral therapies and rigorous monitoring, may impede the drop in renal function.

Wouter Lollinga, MSc, University Medical Center Groningen, Groningen, Netherlands

Disclosures:

W. Lollinga, None

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