NEW MICROBIOLOGICA, 36, 363-371, 2013 HCMV infection in renal transplant recipients: a retrospective cohort study Camilla Puttini 1 , Mario Carmellini 2 , Guido Garosi 3 , Barbara Rossetti 1 , Maria Letizia Riccio 1 , Giacinta Tordini 1 , Maria Grazia Cusi 4 , Andrea De Luca 1 , Giacomo Zanelli 1 1 Infectious Diseases Section, Department of Medical Biotechnologies, University Hospital, Siena, Italy; 2 Transplantation Surgery, University Hospital, Siena, Italy; 3 Nephrology, Dialysis and Transplant Unit, University Hospital, Siena, Italy; 4 Section of Microbiology, Department of Medical Biotechnologies, University Hospital, Siena, Italy INTRODUCTION Despite recent improvements in transplantation practices, Human Cytomegalovirus (HCMV) in- fection still represents the most common viral complication affecting solid organ transplant re- cipients (SOTRs), resulting not only in significant morbidity but also in mortality, and influencing many short and long-term indirect effects that collectively contribute to reduced allograft and patient survival (Fishman et al., 2007). Therefore, HCMV disease prevention remains one of the Corresponding author Puttini Camilla Infectious Diseases Section Department of Medical Biotechnologies University of Siena Viale Bracci - 53100 Siena, Italy E-mail: camilla.puttini@libero.it principal goals of SOTRs management and sev- eral approaches are used. Some guidelines rec- ommend specific pre-emptive anti-HCMV thera- py in asymptomatic viremic patients (Gerna et al., 2007; Baldanti et al., 2008), whereas others combine this strategy with a pharmacological prophylaxis for patients belonging to high-risk groups, such as HCMV seronegative recipients from an HCMV seropositive donor (KDIGO Transplant Work Group, 2009; Kotton et al., 2010). Other approaches range from universal, delayed or prolonged pharmacological prophy- laxis for established durations (San Juan et al., 2009; Kotton et al., 2010; Leone et al., 2010; Blumberg et al., 2010), to extremely selective pre- emptive treatment strategies, still under investi- gation, evaluating HCMV viral load and specific immune response (Gerna et al., 2006; Gerna et al., 2011). The former is based on the rationale that HCMV replication itself, even at low levels Human Cytomegalovirus (HCMV) represents the most common viral complication affecting solid organ transplant recipi- ents (SOTRs) and its management is still debated. This study analyzes the association between HCMV infection and renal transplant recipients’ outcomes. From January 2008 through December 2009, 97 consecutive renal transplant recipients were retrospectively studied. HCMV disease prevention was pursued by pre-emptive therapy, reserving long-term prophy- laxis for high-risk patients. A total of 32/97 patients (32.9%) developed HCMV positivity in blood for a cumulative estimat- ed proportion at 3 months post-transplantation of 0.21. HCMV disease developed in 7 patients (7.2%), while 25 patients had asymptomatic infection (25.7%). No patient died from HCMV. HCMV disease, older graft age and post-transplant renal dys- function were independent predictors of rejection while HCMV infection without disease was associated with a higher num- ber of other complications. The use of basiliximab was independently associated with a reduced hazard of HCMV infec- tion/disease. In renal transplant recipients HCMV infection still represents a major issue influencing the outcome, not only because of the potential to develop the disease and its link to graft rejection, but also in terms of higher number of compli- cations. The choice of different immunosuppressive strategies might be associated with HCMV replication. KEY WORDS: HCMV, Renal transplant, Prophylaxis, Pre-emptive therapy, Rejection. SUMMARY Received March 26, 2013 Accepted August 15, 2013