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Risk Factors for Cytomegalovirus Infection in Renal / Pancreatic Transplant

Purpose: To evaluate a renal and/or pancreatic transplant who is at high risk for invasive CMV infection based on the study of Akalin et al.

Description

Akalin et al identified risk factors for cytomegalovirus infection in recipients of renal and/or pancreatic transplant. These can help identify a patient who may benefit from higher dose or prolonged prophylaxis with ganciclovir or valganciclovir). The authors are from Mount Sinai School of Medicine in New York City.


 

Parameters:

(1) induction treatment

(2) CMV status of donor and recipient

(3) age of the patient

 

Parameter

Finding

Points

induction treatment

with thymoglobulin

1

 

without thymoglobulin

0

CMV status

donor positive, recipient negative

1

 

other

0

age of the patient

< 50 years

0

 

>= 50 years

1

 

number of risk factors =

= SUM(points for all 3 parameters)

 

Interpretation:

• minimum number of risk factors: 0

• maximum number of risk factors: 3

• The presence of either thymoglobulin induction or risky CMV status indicates a high risk patient.

• High risk patients may develop invasive CMV disease once prophylaxis is discontinued. These patient require higher doses and/or a longer period of prophylaxis (patients received either ganciclovir or valganciclovir). If infection does develop in a patient receiving prophylaxis, then resistance to the antiviral agent should be tested for.

 


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Specialty

Objective

ICD-10