Incidence and risk factors of cytomegalovirus infection in solid organ transplant recipients: a nationwide Korean study

초록

Cytomegalovirus (CMV) remains one of the most important opportunistic infections following solid organ transplantation, with variable incidence and clinical outcomes depending on organ type, immunosuppressive regimen, and donor-recipient serostatus. We conducted a large-scale retrospective analysis using data from the Korean Organ Transplantation Registry (KOTRY), a prospective multicenter cohort including kidney, liver, heart, and lung transplant recipients. A total of 9,777 adult patients who underwent transplantation between 2014 (lung added in 2015) and December 2022 were analyzed. CMV infection and disease were identified based on clinical diagnosis. Independent risk factors were determined using multivariable Cox regression. The overall incidence of CMV infection was highest among kidney transplant recipients (36.5%), followed by lung (21.3%), liver (12.9%), and heart (6.8%) recipients. Most CMV infections occurred within the first year after transplantation, with lung recipients exhibiting the longest median time to infection (112 days). Risk factors varied by organ: in kidney recipients, antithymocyte globulin (ATG) use and D+/R- serostatus were the strongest predictors; in liver recipients, higher Model for End-Stage Liver Disease scores, refractory ascites, and deceased donor status increased the risk; in heart recipients, ATG administration, desensitization, and CMV immunoglobulin G seronegativity were significant risk factors; and in lung recipients, diabetes and prolonged operation time were associated with higher infection rates. CMV infection significantly worsened patient survival among kidney, liver, and lung recipients. The incidence and risk factors of CMV infection differ substantially across organ types, yet its impact on outcomes remains considerable. These findings highlight the need for organ-specific prevention, monitoring, and novel therapeutic strategies to enable personalized management of transplant recipients.

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