Characteristics and Outcomes of Cytomegalovirus Infection in Seropositive Kidney Transplant Recipients in the Era of Antiviral Prophylaxis with Valacyclovir: A Single-Center Study in Morocco
Received 25 August 2020
Accepted for publication 5 January 2021
Published 25 January 2021 Volume 2021:13 Pages 1—13
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Qing Yi
Bouchra Rezzouk,1 Tarik Bouattar,2,3 Bouchra Belkadi,1 Rachid Razine,4 Rabia Bayahia,2,3 Naima Ouzeddoun,2,3 Loubna Benamar,2,3 Hakima Rhou,5 Najat Bouihat,6 Azeddine Ibrahimi,3,7 Myriam Seffar,3,6 Hakima Kabbaj3,6
1Laboratory of Microbiology and Molecular Biology, Faculty of Science, University Mohammed V, Rabat, Morocco; 2Department of Nephrology, Dialysis, Renal Transplantation, Ibn Sina University Hospital Center, Rabat, Morocco; 3Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco; 4Laboratory of Social Medicine, Epidemiology and Clinical Research, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco; 5Department of Nephrology, Dialysis, Renal Transplantation, Sheikh Zaid International University Hospital, Rabat, Morocco; 6Central Laboratory of Virology, Hospital of Specialties, Ibn Sina University Hospital Center, Rabat, Morocco; 7Biotech Laboratory (Med Biotech), Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
Correspondence: Bouchra Rezzouk 7, Avenue Madagascar, Rabat, Morocco
Tel + 212 64 94 31 25
Purpose: Despite the use of antiviral prophylaxis with valacyclovir, cytomegalovirus infection (CMV) can still occur in seropositive kidney transplant recipients. In this study, we aimed to assess the incidence of CMV DNAemia and its risk factors in Moroccan transplant recipients.
Patients and Methods: Sixty kidney recipients with positive cytomegalovirus serostatus, receiving post-transplant prophylaxis were enrolled between 2013 and 2017. In total, 455 plasma samples were collected and tested for CMV DNAemia using PCR-based Abbott RealTime assays.
Results: The incidence of CMV infection in seropositive patients was 63%. In patients with quantifiable DNAemia, the duration of CMV infection was significantly shorter than in those with detectable DNAemia (141.5 ± 96.9 vs 294.1 ± 112.6 days, P < 0.001). During prophylactic treatment, 14 of 30 patients (47.0%) experienced active replication with quantifiable DNAemia, whereas none of eight patients with detectable DNAemia did (P = 0.017). Patients with symptomatic DNAemia were significantly younger than those without symptoms (28.8 ± 5.12 vs 38.1 ± 12.34 years, P = 0.007). The peak viral loads were significantly associated with viral disease (odds ratio: 3.39, 95% confidence interval: 1.21– 9.53, P = 0.02). The duration of DNAemia (21.2 vs 13.4 days, P = 0.028) was significantly longer in symptomatic patients. Significantly higher rates of acute rejection were exclusively observed in recipients with disease (4/8, 50% vs 0/22, 0%, P = 0.003).
Conclusion: Patients with high-level DNAemia were at an increased risk of progression to disease and acute rejection. Monitoring the viral load during the first year post-transplantation is essential, to support current preventive strategies.
Keywords: cytomegalovirus, DNAemia, kidney transplant, disease, acute rejection
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