신장이식 이후 약물사용에 따른 Cytomegalovirus 감염의 위험요인 분석

Abstract

Cytomegalovirus(CMV), the most common virus which causes opportunistic infection can be reactivated in patients with immunosuppressive therapy after kidney transplantation. In many studies, CMV high-risk group was identified in patients whose transplantations were conducted from seropositive donors to seronegative recipients. So, it was recommended that those patients should receive prophylactic anti-viral therapy after transplantations. Although most Koreans have antibodies against CMV, CMV infections are observed in patients with kidney transplantation. Therefore, this study aimed to analyze the main risk factors of CMV infections including CMV serotypes and other risk factors. We retrospectively analyzed medical records of patients who have received a renal allograft from January 2006 to December 2007 in Asan Medical Center and monitored them for 1.5 year after transplantations. Among 248 kidney patients with transplantation, 22 patients (8.9%) developed CMV infection. No significant differences were observed regarding the selective use of cyclosporine/tacrolimus and azathioprine/mycophenolate. Donor’s age, sex and the use of induction therapy were not significant factors of CMV infection. But acute rejection (p<0.001) and the use of prophylactic anti-viral therapy (p=0.014) were found to be significant factors between patients with and without CMV infection. With logistic regression analysis using risk factors and other relevant factors, acute rejection and prophylactic anti-viral therapy were significant factors of CMV infection. This study suggests acute rejection and anti-viral therapy are relative risk factors after kidney transplantation.