Effect of Cytomegalovirus Prophylaxis with Acyclovir on Renal Transplant Survival

Figures & data

Table 1 Univariate analysis of factors affecting graft survival

Variable	Hazard ratio	p value	95% confidence interval
CMV positivity	1.631	<0.001	1.247–2.134
Recipient age	1.016	0.001	1.007–1.025
Donor age	1.025	<0.001	1.016–1.034
Delayed graft function	2.222	<0.001	1.576–3.134
Donor male sex	0.757	0.046	0.576–0.995
Recipient male sex	0.918	0.553	0.694–1.216
> 1 transplant	1.240	0.164	0.916–1.679
PRA	1.002	0.407	0.997–1.007
HLA mismatch	1.000	0.776	0.998–1.002
Number of acute rejections	1.386	<0.001	1.218–1.577

Table 2 Multivariable model of risk factors associated with graft loss

Variable	Hazard ratio	p value	95% confidence interval
CMV positivity	1.277	0.049	1.001–1.630
Donor age	1.017	<0.001	1.009–1.025
Delayed graft function	1.507	0.040	1.019–2.230
Recipient age	1.006	0.147	0.998–1.015
Donor male sex	0.869	0.253	0.684–1.105
Number of acute rejections	1.365	<0.001	1.204–1.547

Figure 1. The effect of CMV infection on graft survival, despite acyclovir prophylaxis, adjusted for age and transplant number. X axis: Graft survival in years Y axis: Percentage of grafts surviving.

Table 3 Comparison of treatment group versus D-R- patients

Variable	Treatment	D-R-	p value
Number of recipients	487	448	—
Median age in years [range]	45 [4–73]	37 [2–76]	< 0.001
> 1 transplant	19%	13%	0.014
Gender, % female	36.9	35.3	0.614
PRA > 80%	7.8%	6.26%	0.398
Favorable HLA match	18.4%	18%	0.897
Mortality	12.44%	7.9%	0.022
Death with functioning graft	14.18%	8.68%	0.014
Prevalence of diabetes mellitus	7.21%	6.84%	0.819
ESRD from glomerulonephritis	30.6%	33.33%	0.36
Delayed graft function	9.16%	5.13%	0.015

Figure 2. The effect of donor and/or recipient CMV infection on graft survival. X axis: Graft survival in years Y axis: Percentage of grafts surviving.

Table 4 Comparison of different subgroups of CMV-positive or -negative transplants

CMV group	D−R−	D−R+	D+R−	D+R+
Number of transplants	468	169	225	116
Mean age, years	37.94	43.65	41.51	44.08
Graft losses observed	53	19	40	18
Graft losses expected	66.11	22.1	27.44	14.35
Difference in graft survival^†	—	0.941	0.0131	0.0214

*In the DR+ group, there were insufficient data on 11 transplants to differentiate between D−/R+, D+/R−, and D+/R+.

^†p value according to log rank test for equality of survivor functions in comparison to the D−/R− group.

Abbreviations: D = donor, R = recipient, − = CMV-negative, + = CMV-positive

Table 5 Graft survival over one, three, and five years

CMV group	One year %	Three year %	Five year %
D-R-	89.1	85.7	79.4
D-R+	87.4	78	74.3
D+R-	81.1	75.7	65.9
D+R+	84.6	73.4	59.7