Clinico-epidemiological characteristics of early- versus late-onset cytomegalovirus disease among renal transplant recipients: A two-decade experience

Background Reactivation of cytomegalovirus (CMV) infection in transplant patients is high because of immunosuppression. We have evaluated clinical and epidemiological characteristics of early versus late onset of CMV infection among renal transplant recipients. Methods A single center retrospective observational study was conducted among renal transplant recipients who underwent kidney transplant between January 2002, and December 2021. CMV disease was classified as early or late depending on the detection prior or after 90 days post-transplantation. Herein, we reported the differences in clinical symptoms between early and late onset of CMV disease, the use of immunosuppression, and the impact on graft outcomes. Results Out of total 2164 renal transplant recipients, 156 patients (7.2%) were diagnosed with CMV disease. Among these 156 patients, 25 patients (16%) had early CMV while 131 patients (84%) had late CMV. Overall, the two groups did not differ with respect to the induction or maintenance of immunosuppressive agents. However, the proportion of CMV syndrome was greater among early (56.0%) than late (26.7%) CMV groups (p = 0.01). In contrast, tissue invasive disease was more frequent among late (73.3%) in comparison to early (44.0%) CMV groups (p = 0.01). Among clinical symptoms, diarrhea was more frequent in late (63.4%) vs. early (36%) CMV-affected patients (p = 0.01). Graft loss occurred in 4.0% of early CMV group vs. 25.2% of late CMV group (p = 0.03). Neither of the clinical groups differed with respect to occurrence of biopsy-proven allograft rejection post-infection. Conclusions The early CMV disease presents more frequently with CMV symptoms while the late CMV disease usually manifests itself as the tissue invasive disease. Graft loss is more common in patients with late onset of CMV disease.