Cytomegalovirus disease recurrence after ganciclovir treatment in kidney and kidney-pancreas transplant recipients

Background. With the introduction of ganciclovir, the clinical pattern of c ytomegalovirus (CMV) disease has changed; CMV disease recurrence after succ essful treatment of the initial episode has emerged as a more common proble m. We studied CMV disease recurrence in kidney transplant (KTx) and simulta neous kidney-pancreas transplant (SPK) recipients, and identified risk fact ors for recurrence. Methods. Between January 1987 and December 1995, of 1272 KTx and 287 SPK re cipients, 332 developed CMV disease and were treated with a 14-day course o f i.v. ganciclovir, followed by a 10-week course of oral acyclovir, Among t hese 332 recipients, 103 (31%) developed CMV disease recurrence more than 3 0 days after treatment for the initial episode; this group was compared wit h those recipients who did not develop recurrence (n=229), Risk factors exa mined were age, presence of diabetes, type of transplant (KTx vs. SPK), don or source (cadaver vs. living donor), treatment for acute rejection, pretra nsplant CMV serologic status, evidence of tissue-invasive CMV, and treatmen t of the initial episode with human immune globulin in addition to ganciclo vir, Results. Univariate analysis found that patients with recurrence were more likely to be diabetic (70.9% vs. 53.7%; P=0.04), to have undergone an SPK ( 39.8% vs. 20.5%; P=0.004), to have received a cadaver organ (78.6% vs. 61.6 %; P=0.002), and to have received treatment for acute rejection (78.6% vs. 59.8%; P=0.001), Using multivariate analysis, two statistically significant risk factors were found: receiving a cadaver organ (relative risk [RR]=1.9 0; P=0.03) and treatment for acute rejection (RR=2.02; P=0.008), Diabetes ( RR=1.44; P=0.18) and a cadaver SPK transplant (RR=1.55; P=0.12) tended towa rd increased risk for recurrence, but the difference did not reach statisti cal significance, The remaining variables were not significant, Interesting ly, CMV recurrence did not significantly diminish B-year graft survival (52 .0% vs. 54.4%; P not significant) or patient survival (67.0% vs. 68.3%; P n ot significant) rates. Conclusions. CMV disease recurs in roughly one-third of KTs and SPK recipie nts after treatment of the initial episode with ganciclovir, A cadaver orga n source and treatment for acute rejection were the most significant clinic al risk factors for recurrence. Clinical predictors of recurrence such as t hese may help to identify those recipients who need more intensive therapeu tic and prophylactic regimens.