IS CYTOMEGALOVIRUS-INFECTION RELATED TO MYCOPHENOLATE-MOFETIL AFTER KIDNEY-TRANSPLANTATION - A CASE-CONTROL STUDY

Three multicenter studies have shown that the addition of mycophenolat e mofetil (MMF) to an immunosuppressive regime consisting of cyclospor in A (CSA) and prednisone (PRED) decreases the incidence of acute reje ction episodes when compared with azathioprine (AZA) or placebo (1-3). In those patients receiving 3 g/d of MMF, the highest dose used in th e studies, there was a trend towards an increased incidence of cytomeg aloviral sepsis (CMV). We postulated therefore that MMF may represent an independent risk factor for the development of CMV infection in pat ients receiving renal allografts and MMF at our institution, Having al tered the triple drug regime from CSA, AZA (2-2.5 mg/kg/d) and PRED to CSA, MMF (2 g/d) and PRED in July 1995, we elected to study all patie nts undergoing kidney transplantation for the 33-month period January 1994-September 1996, by undertaking a case control analysis to determi ne independent risk factors for the development of CMV infection, as d efined by CMV viremia or tissue-invasive CMV. Three CMV disease-free c ontrol patients were matched to each case? these patients having been randomly selected from the entire pool of patients in the observation period. There were 31 CMV case patients and 102 control patients. Univ ariate analysis indicated that gender, a concomitant pancreas transpla nt, acute rejection and CMV seropositivity in the donor were risk fact ors. However, multivariate analysis indicated that only acute rejectio n and donor CMV seropositivity were independently linked (p < 0.05) to CMV disease in this sample. Specifically, the odds ratio (OR) for CMV disease between MMF and AZA was 1.0 (95% confidence interval (CI): 0. 46-2.18). Therefore, in this case control study we find no evidence th at MMF at a dose of 2 gd is an independent risk factor for primary CMV viremia or tissue invasion in renal allograft recipients.