Abstract
Introduction: Cytomegalovirus infection (CMVI) is a common complication in solid organ transplants. Belatacept (BTC) is an immunosuppressant that blocks CD28-mediated T cell costimulation. The objective of this research is to evaluate the characteristics of ICMV in kidney transplant recipients under BTC. Patients and Methods: retrospective study. CMVI episodes in KT with BTC between 2011-2023, at Hospital Britanico BA, were included. Results: 39 patients with BTC. CMVI: 12/39 (30.7%); total episodes CMVI: 29. Time of onset of CMVI post-transplant: 34 months (IQR 13.5-138); post BTC: 25 months (IQR 9.6-78). Presentation: 19 asymptomatic, 5 viral syndromes and 5 CMV disease (gastrointestinal 3, retinitis 1, pneumonia 1) in 4 patients. The 14/29 episodes (48%) required treatments and were prolonged (28 d; IQR 14-121). In 15/29 (51.7%) they were not treated because they were non-quantifiable DNAemias, with spontaneous control of the same. Negativization of DNAemia was after 20 days (IQR 14-120 d). Overall mortality 7/39 patients (18%), non-attributable to CMVI. Conclusions: consider screening for CMVI in KT with BTC since almost a third of the patients presented CMVI. All were late with respect to TR and BTC, and 36% had organ disease. The negativization of the DNAemias required prolonged treatments. Asymptomatic patients with “detectable and unquantifiable” viral loads could be managed without antivirals, without risk of progression to disease. There was no mortality associated with CMVI.
References
Humar, A., Michaels, M. & AST ID Working Group on Infectious Disease Monitoring. American Society of Transplantation recommendations for screening, monitoring and reporting of infectious complications in immunosuppression trials in recipients of organ transplantation. Am. J. Transplant 6, 262–274 (2006). DOI: 10.1111/j.1600-6143.2005.01207.x
Bray, R. A. et al. Posttransplant reduction in preexisting donor-specific antibody levels after belatacept- versus cyclosporine-based immunosuppression: Post hoc analyses of BENEFIT and BENEFIT-EXT. Am. J. Transplant 18, 1774–1782 (2018). DOI: 10.1111/ajt.14738
Karadkhele, G. et al. CMV high-risk status and posttransplant outcomes in kidney transplant recipients treated with belatacept. Am. J. Transplant 21, 208–221 (2021). DOI: 10.1111/ajt.16132
Magua, W. et al. Impact of belatacept and tacrolimus on cytomegalovirus viral load control and relapse in moderate and high-risk cytomegalovirus serostatus kidney transplant recipients. Transpl. Infect. Dis. 24, e13983 (2022). DOI: 10.1111/tid.13983
Le Meur, Y. et al. Effect of an Early Switch to Belatacept Among Calcineurin Inhibitor-Intolerant Graft Recipients of Kidneys From Extended-Criteria Donors. Am. J. Transplant 16, 2181–2186 (2016). DOI: 10.1111/ajt.13698
Chavarot, N. et al. Increased incidence and unusual presentations of CMV disease in kidney transplant recipients after conversion to belatacept. Am. J. Transplant 21, 2448–2458 (2021). DOI: 10.1111/ajt.16430
Fan, J. et al. CYTOMEGALOVIRUS RETINITIS WITH BELATACEPT IMMUNOSUPPRESSION. Retin. Cases Brief Rep. 16, 199–203 (2022). doi: 10.1097/ICB.0000000000000928.
Deliège, P.-G. et al. Belatacept associated - cytomegalovirus retinitis in a kidney transplant recipient: a case report and review of the literature. BMC Ophthalmol. 20, 468 (2020). DOIhttps://doi.org/10.1186/s12886-020-01741-1
Ljungman, P. et al. Definitions of Cytomegalovirus Infection and Disease in Transplant Patients for Use in Clinical Trials. Clin. Infect. Dis. 64, 87–91 (2017). doi: 10.1093/cid/ciw668. Epub 2016 Sep 28.
Vincenti, F. et al. A phase III study of belatacept-based immunosuppression regimens versus cyclosporine in renal transplant recipients (BENEFIT study). Am. J. Transplant 10, 535–546 (2010). doi: 10.1111/j.1600-6143.2009.03005.x
Website. Axelrod DA, Chang SH, Lentine KL, et al. The clinical and economic benefit of CMV matching in kidney transplant: a decision analysis. Transplantation. 2022;106(6):1227-1232. https://doi.org/10.1097/TP. 0000000000003887.
Website. Lorenz EC, Egginton JS, Stegall MD, et al. Patient experience after kidney transplant: a conceptual framework of treatment burden. J Patient-Rep Outcomes. 2019;3(1):8. https://doi.org/10.1186/s41687- 019-0095-4.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2026 Matias Monkowski, Patricia Giorgio, Carolina Gabriela Lozina, Leonel Langellotti, Mariana Ursino, Oscar Chávez Choque, Rosana Jordán, Hernán Trimarchi