Taming the Transplant Troll: Exploring Racial and Ethnic Disparities in Cytomegalovirus Infection Among Kidney Transplant Patients

Overview

Journal PLoS One

Date 2025 Jan 29

PMID 39879165

Authors

M Gabriela Cabanilla

Ashlee Dauenhauer

Briana St John

Deirdre Hill

Joshua Larson

Affiliations

Soon will be listed here.

Abstract

Background: Cytomegalovirus (CMV) infection poses a significant risk to kidney transplant recipients. This study investigated CMV disease incidence, outcomes, and management challenges in racial and ethnic minority populations following kidney transplantation.

Methods: This single-center, mixed-methods study included a retrospective cohort analysis of kidney transplant recipients (n = 58) and qualitative surveys of healthcare providers. Patients were categorized as minorities (n = 49) or non-Hispanic whites (n = 9). The primary outcome was CMV disease incidence. Secondary outcomes included graft failure, mortality, and identification of management barriers.

Results: The cumulative incidence of CMV disease was higher in minorities than in non-Hispanic whites (12.3% vs. 0%, p = 0.58), although the difference was not statistically significant. All graft failures (8.6%, n = 5) occurred in the minority group. Although not statistically significant, all-cause mortality was higher in the minority group (24.5% vs. 11.1%, p = 0.54), with 46.2% of the deaths occurring within 90 days of CMV diagnosis. Qualitative analysis revealed challenges in diagnosis, treatment-related side effects, medication costs, and insurance barriers. The providers emphasized the importance of interdisciplinary collaboration and standardized protocols.

Conclusion: While limited by the small sample size, this study highlights potential disparities in the incidence and outcomes of CMV disease among minority kidney transplant recipients, suggesting that barriers in care and access may contribute to these differences. These hypothesis-generating findings underscore the need for larger multicenter studies to validate these patterns and to inform targeted strategies that may reduce inequities in post-transplant outcomes.

References

Bristow B, OKeefe K, Shafir S, Sorvillo F . Congenital cytomegalovirus mortality in the United States, 1990-2006. PLoS Negl Trop Dis. 2011; 5(4):e1140. PMC: 3082510. DOI: 10.1371/journal.pntd.0001140. View

Sridhar V, Ambinathan J, Gillard P, Mathieu C, Cherney D, Lytvyn Y . Cardiometabolic and Kidney Protection in Kidney Transplant Recipients With Diabetes: Mechanisms, Clinical Applications, and Summary of Clinical Trials. Transplantation. 2021; 106(4):734-748. DOI: 10.1097/TP.0000000000003919. View

Boge C, Hayes McDonough M, Newman A, Blumenstock J, Elgarten C, Freedman J . Disparities in Cytomegalovirus Infection Rates by Race and Ethnicity among Pediatric Allogeneic Hematopoietic Cell Transplantation Recipients at a Single Center. Transplant Cell Ther. 2024; 30(3):328.e1-328.e12. DOI: 10.1016/j.jtct.2024.01.055. View

Wolf S, Lauseker M, Schiergens T, Wirth U, Drefs M, Renz B . Infections after kidney transplantation: A comparison of mTOR-Is and CNIs as basic immunosuppressants. A systematic review and meta-analysis. Transpl Infect Dis. 2020; 22(3):e13267. DOI: 10.1111/tid.13267. View

Witzke O, Hauser I, Bartels M, Wolf G, Wolters H, Nitschke M . Valganciclovir prophylaxis versus preemptive therapy in cytomegalovirus-positive renal allograft recipients: 1-year results of a randomized clinical trial. Transplantation. 2011; 93(1):61-8. DOI: 10.1097/TP.0b013e318238dab3. View

Cannon M, Schmid D, Hyde T . Review of cytomegalovirus seroprevalence and demographic characteristics associated with infection. Rev Med Virol. 2010; 20(4):202-13. DOI: 10.1002/rmv.655. View

Simon D, Levin S . Infectious complications of solid organ transplantations. Infect Dis Clin North Am. 2001; 15(2):521-49. DOI: 10.1016/s0891-5520(05)70158-6. View

Merzkani M, Bentall A, Smith B, Benavides Lopez X, DCosta M, Park W . Death With Function and Graft Failure After Kidney Transplantation: Risk Factors at Baseline Suggest New Approaches to Management. Transplant Direct. 2022; 8(2):e1273. PMC: 8759617. DOI: 10.1097/TXD.0000000000001273. View

Desai R, Collett D, Watson C, Johnson P, Moss P, Neuberger J . Impact of Cytomegalovirus on Long-term Mortality and Cancer Risk After Organ Transplantation. Transplantation. 2015; 99(9):1989-94. DOI: 10.1097/TP.0000000000000641. View

10.

Razonable R, Humar A . Cytomegalovirus in solid organ transplantation. Am J Transplant. 2013; 13 Suppl 4:93-106. DOI: 10.1111/ajt.12103. View

11.

Savva G, Pachnio A, Kaul B, Morgan K, Huppert F, Brayne C . Cytomegalovirus infection is associated with increased mortality in the older population. Aging Cell. 2013; 12(3):381-7. DOI: 10.1111/acel.12059. View

12.

San Juan R, Aguado J, Lumbreras C, Fortun J, Munoz P, Gavalda J . Impact of current transplantation management on the development of cytomegalovirus disease after renal transplantation. Clin Infect Dis. 2008; 47(7):875-82. DOI: 10.1086/591532. View

13.

Grams M, Massie A, Schold J, Chen B, Segev D . Trends in the inactive kidney transplant waitlist and implications for candidate survival. Am J Transplant. 2013; 13(4):1012-1018. PMC: 3892904. DOI: 10.1111/ajt.12143. View

14.

Harris P, Taylor R, Thielke R, Payne J, Gonzalez N, Conde J . Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2008; 42(2):377-81. PMC: 2700030. DOI: 10.1016/j.jbi.2008.08.010. View

15.

Khoury J, Storch G, Bohl D, Schuessler R, Torrence S, Lockwood M . Prophylactic versus preemptive oral valganciclovir for the management of cytomegalovirus infection in adult renal transplant recipients. Am J Transplant. 2006; 6(9):2134-43. DOI: 10.1111/j.1600-6143.2006.01413.x. View

16.

Epstein A, Ayanian J, Keogh J, Noonan S, Armistead N, Cleary P . Racial disparities in access to renal transplantation--clinically appropriate or due to underuse or overuse?. N Engl J Med. 2000; 343(21):1537-44, 2 p preceding 1537. PMC: 4598055. DOI: 10.1056/NEJM200011233432106. View

17.

Balfour Jr H . Cytomegalovirus: the troll of transplantation. Arch Intern Med. 1979; 139(3):279-80. DOI: 10.1001/archinte.139.3.279. View

18.

Freyer C, Carulli A, Gier S, Ganetsky A, Timlin C, Schuster M . Letermovir vs. high-dose valacyclovir for cytomegalovirus prophylaxis following haploidentical or mismatched unrelated donor allogeneic hematopoietic cell transplantation receiving post-transplant cyclophosphamide. Leuk Lymphoma. 2022; 63(8):1925-1933. DOI: 10.1080/10428194.2022.2042686. View

19.

Lantos P, Permar S, Hoffman K, Swamy G . The Excess Burden of Cytomegalovirus in African American Communities: A Geospatial Analysis. Open Forum Infect Dis. 2015; 2(4):ofv180. PMC: 4691661. DOI: 10.1093/ofid/ofv180. View

20.

Bate S, Dollard S, Cannon M . Cytomegalovirus seroprevalence in the United States: the national health and nutrition examination surveys, 1988-2004. Clin Infect Dis. 2010; 50(11):1439-47. PMC: 11000537. DOI: 10.1086/652438. View