Table 1.
Characteristics of Patients With Relapsing Cytomegalovirus Infection Within 6 Months Compared to Those Without Relapse, and Unadjusted Hazard Ratios for Relapse
| Characteristic | Overall (N = 170) |
No Relapse (n = 137) | Relapse (n = 33) |
Unadjusted HR (95% CI) |
P Value |
|---|---|---|---|---|---|
| Age at CMV onset, y, median (range) | 54.5 (14–80) | 53 (14–79) | 60 (18–80) | 1.03 (1–1.06) | .05 |
| Male sex | 111 (65) | 90 (66) | 21 (64) | 0.92 (.45–1.88) | .83 |
| Race, white (vs nonwhite) | 127 (75) | 104 (76) | 23 (70) | 0.78 (.37–1.64) | .51 |
| Year of CMV infection, median (range) | 2007 (1995–2016) | 2007 (1995–2016) | 2009 (1995–2015) | 1.08 (1.01–1.16) | .03 |
| Transplanted organ | |||||
| Heart | 52 (31) | 46 (34) | 6 (18) | Ref | |
| Liver (including liver–kidney) | 34 (20) | 34 (25) | 5 (15) | 1.08 (.33–3.55) | .89 |
| Kidney (living unrelated donor) | 16 (9) | 8 (6) | 8 (24) | 5.33 (1.85–15.37) | .002 |
| Kidney (deceased donor) | 48 (28) | 10 (30) | 10 (30) | 1.77 (.64–4.86) | .27 |
| Kidney (living related donor) | 15 (9) | 4 (12) | 4 (12) | 2.35 (.66–8.34) | .19 |
| Previous transplant | 16 (9) | 13 (10) | 3 (9) | 0.99 (.30–3.26) | .99 |
| Recipient CMV seronegative pretransplant | 92 (54) | 71 (51) | 21 (64) | 1.57 (.77–3.20) | .21 |
| Any antilymphocyte agent within 1 y before CMV treatment completion | 61 (36) | 42 (31) | 19 (58) | 2.61 (1.31–5.21) | .006 |
| Type of antilymphocyte agent | |||||
| None | 109 (64) | 95 (69) | 14 (42) | Ref | |
| Basiliximab/daclizumab | 13 (8) | 7 (5) | 6 (18) | 4.47 (1.72–11.64) | .002 |
| ATG/OKT3 | 48 (28.2) | 35 (26) | 13 (39) | 2.19 (1.03–4.67) | .04 |
| No. of immunosuppressive drugs | |||||
| 1 | 13 (8) | 9 (7) | 4 (10) | Ref | |
| 2 | 85 (50) | 64 (49) | 21 (54) | 0.65 (.22–1.93) | .44 |
| 3 | 72 (42) | 58 (44) | 14 (36) | 0.53 (.17–1.66) | .28 |
| Steroid-treated rejection | |||||
| Within 1 y before treatment completion | 38 (22) | 36 (26) | 2 (6) | 0.21 (.05–.87) | .03 |
| Following treatment completion to censoring | 10 (6) | 6 (4) | 4 (12) | 2.2 (.78–6.30) | .14 |
| Time from transplant to CMV onset, wk, median (range) | 31 (4–1131) | 33 (6–1131) | 29 (4–755) | 1.00 (.99–1.01) | .91 |
| Clinical details | |||||
| Time of symptoms prior to proven onset, d, median (range) | 11.5 (0–365) | 12 (0–209) | 11 (0–365) | 1.00 (.99–1.01) | .56 |
| End-organ disease | 120 (71) | 96 (70) | 24 (73) | 1.06 (.49–2.28) | .88 |
| Proven/probable site | 105 (62) | 84 (61) | 21 (64) | 1.04 (.51–2.12) | .91 |
| High viral load | 27 (16) | 18 (13) | 9 (27) | 2.40 (1.12–5.17) | .03 |
| Admitted for CMV | 134 (79) | 107 (78) | 27 (82) | 1.26 (.52–3.04) | .61 |
| Length of stay, d, median (range) (n = 134) | 6 (1–46) | 5 (1–46) | 7 (2–39) | 1.03 (1.00–1.08) | .07 |
| Length of antiviral therapy, d, median (range) | 28.5 (3–201) | 26 (3–201) | 40 (3–145) | 1.01 (1.00–1.02) | .004 |
| Treatment type | |||||
| Oral only | 72 (42) | 60 (44) | 12 (36) | Ref | |
| IV and oral | 64 (38) | 50 (37) | 14 (42) | 1.36 (.63–2.93) | .44 |
| IV only | 34 (20) | 27 (20) | 7 (21) | 1.28 (.50–3.26) | .60 |
| Adjunctive CMV immune globulin | 17 (10) | 8 (6) | 9 (27) | 5.16 (2.39–11.14) | <.001 |
| Laboratory results, mean ± SD | |||||
| Total WBC count, ×103 cells/μL (n = 140) | 4.62 ± 2.57 | 4.70 ± 2.66 | 4.33 ± 2.21 | 0.94 (.80–1.10)a | .44 |
| ALC, ×103 cells/μL (n = 133) | 1.01 ± 0.66 | 1.08 ± 0.69 | 0.73 ± 0.42 | 1.11 (1.03–1.21)b | .009 |
| ANC, ×103 cells/μL (n = 133) | 3.01 ± 1.93 | 2.97 ± 1.89 | 3.19 ± 2.10 | 1.04 (.86–1.25)a | .70 |
| CKD-EPI eGFR, mL/min/1.73 m2 (n = 140) | 57 ± 25 | 57 ± 25 | 55 ± 25 | 1.00 (.98–1.01)a | .56 |
| Received secondary prophylaxis | 120 (71) | 97 (71) | 23 (70) | 0.91 (.43–1.92) | .81 |
| Duration of secondary prophylaxis, d, median (range) (n = 120) | 60.5 (5–180) | 66 (5–180) | 55 (5–105) | 0.98 (.97–.99) | .01 |
Data are presented as No. (%) and refer to the time of CMV treatment completion, unless otherwise stated.
Abbreviations: ATG, antithymocyte globulin; ALC, absolute lymphocyte count; ANC, absolute neutrophil count; CI, confidence interval; CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration; CMV, cytomegalovirus; eGFR, estimated glomerular filtration rate; HR, hazard ratio; IV, intravenous; OKT3, muromonab-CD3; SD, standard deviation; WBC, white blood cell.
aHRs displayed to reflect effect per each 1-unit increase in value.
bHRs displayed to reflect effect per each incremental decrease of 100 cells/μL in the ALC.