Page 50 - JCTR-11-2

Journal of Clinical and
Translational Research CMV secular trends and race

Figure 1. Consolidated standards of reporting trials diagram. The diagram details how the cohort was formed, including exclusion reasons and number
of patients.
Abbreviations: CMV: Cytomegalovirus; yo: Years old.

Temporal trend analysis demonstrated increasing CMV risk is partially explained by higher acute rejection rates in
D+/R− rates over time, with AAs having 51% lower odds AAs. In addition, AA race was associated with increased
of being CMV D+/R− (odds ratio = 0.49, CI: 0.40 – 0.61, risks of graft loss and death-censored graft loss, which have
p<0.001), which remained stable over the 10-year study not changed appreciably over the past decade.
period (p=0.80 for AA * kidney transplant year interaction) Early studies dating back to the 1980s and 1990s
(Figure 2). Sequential Cox modeling also demonstrated consistently reported a higher prevalence of CMV
that in adjusted models, the higher risk of developing infections among AAs compared to Caucasians, a pattern
CMV infection and late CMV infection in AAs did not 20,21
change significantly over time (three-way interaction: that persists. Studies conducted in the first decade of
the 21 century reported CMV seropositivity rates of 84%
st
D+/R− * AA * transplant year, p>0.20). Similarly, risks of 22
acute rejection, graft loss, and death-censored graft loss among AA adults. Our findings align with these trends,
in AAs remained relatively stable over the 10-year study demonstrating a 50% higher risk of CMV infection and
period (three-way interaction: D+/R− * AA * transplant late CMV infection in AAs after controlling for their
year, p>0.20). lower likelihood of being D+/R−. This underscores the
significance of race as a robust risk factor for CMV infection
4. Discussion in kidney transplant recipients. Sequential modeling
demonstrated that the higher rates of acute rejection in
This study, involving 2,261 transplanted kidney recipients AAs may partially explain this higher risk. However, in
from January 2012 to June 2021, revealed a secular trend fully adjusted models, including baseline characteristics
for rising CMV D+/R− rates over time. Notably, AAs had and acute rejection, the risk of CMV infection in AAs was
51% lower odds of being CMV D+/R− compared to non- 41% higher than that of non-AAs, indicating that other
AAs, a trend that has remained stable over the 10-year
study period. After adjusting for CMV serostatus, AAs had unmeasured or unknown factors are likely involved.
a 41 – 68% higher risk of developing CMV infection and a Our study also highlights continued poorer outcomes in
50 – 63% higher risk of late CMV infection. This increased AA kidney transplant recipients, consistent with previous

Volume 11 Issue 2 (2025) 44 doi: 10.36922/jctr.24.00067