Page 47 - JCTR-11-2

Journal of Clinical and

Translational Research

ORIGINAL ARTICLE
Secular trends in cytomegalovirus risk and

outcomes by race: A 10-year longitudinal study
in adult kidney transplant recipients

Karim Soliman 1,2,3 , Ahmed Daoud , Amy Perry * , Morgan Overstreet 3 ,
2,3
1
Erika Andrade , Isabel K. Calimlim 3 , Courtney E. Harris 4 , and David J. Taber 3,5
3
1 Department of Medicine Service, Ralph H. Johnson VA Healthcare System, Charleston, South
Carolina, United States of America
2 Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston,
South Carolina, United States of America
3 Department of Surgery, Division of Transplant Surgery, Medical University of South Carolina, South
Carolina, United States of America
4 Department of Medicine, Division of Infectious Diseases, Medical University of South Carolina,
South Carolina, United States of America
5 Department of Pharmacy Service, Ralph H. Johnson VA Healthcare System, Charleston, South
Carolina, United States of America

Abstract
Background and aim: Cytomegalovirus (CMV) remains a critical post-transplant
opportunistic infection despite significant advancements in monitoring and therapy.
*Corresponding author: The impact of African-American (AA) race on CMV risk and outcomes has been
Amy Perry
(amy.perry2@va.gov) insufficiently studied. This study aimed to determine secular trends in the incidence
of CMV D+/R− mismatching and evaluate their association with AA race and clinical
Citation: Soliman K, Daoud A, outcomes. Methods: This single-center longitudinal cohort study involved adult
Perry A, et al. Secular trends in
cytomegalovirus risk and outcomes kidney recipients transplanted between January 2012 and June 2021, with follow-up
by race: A 10-year longitudinal study through June 2022. Univariate and multivariate statistics were performed to analyze
in adult kidney transplant recipients. the data. Results: Of 2392 kidney transplant recipients, 2,261 were included in the final
J Clin Transl Res. 2025;11(2):41-51.
doi: 10.36922/jctr.24.00067 analysis after applying exclusion criteria. The mean age was 52 years, 41% were female,
and 57% were black. In addition, 19% were classified as CMV high-risk. Secular trend
Received: October 14, 2024
analysis revealed an increase in CMV D+/R− rates over time. AAs had 51% lower odds of
1st revised: December 3, 2024 being CMV D+/R− (p<0.001), which remained stable over the study period (p=0.80). In
2nd revised: December 9, 2024 adjusted models, AAs had a 50% higher risk of developing CMV infection (Hazard ratio
[HR] = 1.49, confidence interval [CI]: 1.1 – 2.0) and late CMV infection (HR = 1.5, CI: 1.03
Accepted: February 20, 2025
– 2.3), with no significant change over time (p>0.20). AA race was also a risk factor for
Published online: March 20, 2025 acute rejection and death-censored graft loss, with no notable changes observed over
Copyright: © 2025 Author(s). the study period. Conclusion: In kidney transplant recipients, the incidence of CMV D+/
This is an open-access article R− serostatus has increased over the past decade. AAs are 50% less likely to be CMV D+/
distributed under the terms of the R− but have higher normalized rates of other complications, which remained relatively
Creative Commons AttributionNon-
Commercial 4.0 International (CC stable over the study period. Future studies should explore the underlying mechanisms
BY-NC 4.0), which permits all contributing to the higher rates of CMV infection in AAs, which could facilitate the
non-commercial use, distribution, development of targeted interventions. Factors such as immunosenescence and
and reproduction in any medium,
provided the original work is genetic polymorphisms warrant further exploration. Relevance for patients: CMV
properly cited. risk, outcomes, racial disparities in kidney transplant.
Publisher’s Note: AccScience
Publishing remains neutral with Keywords: Cytomegalovirus; Kidney transplant; Racial disparities; Outcomes;
regard to jurisdictional claims in
published maps and institutional Immunosuppression; Infections
affiliations
Volume 11 Issue 2 (2025) 41 doi: 10.36922/jctr.24.00067