Association Between Delayed Graft Function and Cytomegalovirus Infection after Renal Transplant

Association Between Delayed Graft Function and Cytomegalovirus Infection after Renal Transplant | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association Between Delayed Graft Function and Cytomegalovirus Infection after Renal Transplant Luhao Liu, Rongxin Chen, Jiali Cai, Maierheba Wubuli, Boyu Zheng, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5886297/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Delayed graft function (DGF) increases the renal allograft failure risk. The objective of this study was to estimate the incidence of CMV infection and to analyze whether DGF is associated with an increased risk of CMV infection. Methods : This single center, retrospective, cohort study of deceased donor renal transplant recipients assessed CMV outcomes in patients experiencing DGF versus those without DGF. Univariate and multivariate hazard ratios were calculated with a Cox model. Results : Data from 124 recipients were evaluated (Mean age 44.72±9.97 years, 89 males). Cytomegaloviruria during 1 year after transplantation was diagnosed in 16 patients (12.9%). Patients with DGF were at a greater risk of cytomegaloviruria than patients without DGF (P=0.026). Furthermore, the lymphocyte proportion and CD4+ T cells absolute counts of the DGF group were lower than the without DGF group (p= 0.031 and p=0.012). Conclusion : Our data support the hypothesis that renal transplant recipients with DGF are at increased risk of developing cytomegaloviruria. Prospective studies evaluating to monitor CMV viral loads and CD4+ T lymphocyte numbers in patients with DGF are needed. Trial registration： Clinical Research and Application Ethics Committee of the Second Affiliated Hospital of Guangzhou Medical University:2024-hg-ks-46.Registered 22 October 2024. Cytomegalovirus Delayed graft function Kidney transplantation Valganciclovir Background Cytomegalovirus (CMV) infection was one of the main viral infectious complication in solid organ transplant recipients. CMV remain in the body indefinitely, and may have an indirect effects on secondary infections, malignancy, and overall decreased graft and patient survival 1 . Several factors have been found to increase the risk of CMV reactivation, such as an CMV seropositive donor, the use of antilymphocyte-based immunosuppression and the presence of T-cell mediated rejection 2 , 3 . Delayed graft function (DGF), defined as the need for dialysis within 7 days after kidney transplantation, occurs in 25–30% of deceased donor renal transplantations in the US 4 , 5 . The etiology of DGF includes ischemia-reperfusion injury, acute rejection, thrombotic microangiopathy, vascular and surgical complications 6 . DGF has no curative treatment, and patients with DGF frequently receive augmented immunosuppression due to the risk of hyperacute rejection 7 . Therefore, patients with DGF may be at higher risk for CMV infection because of allograft injury and augmented immunosuppressive strategies. The association between DGF and CMV infection are still under investigation. In this study we aimed to evaluate the risk of CMV infection in patients with DGF after kidney transplantation, using our registry data. Material and Methods Study Design This was a single center, retrospective, cohort study assessed CMV infection outcomes in renal transplant recipients receiving prophylaxis with valganciclovir and experiencing DGF. DGF was defined as the need for dialysis within 1 week after kidney transplantation 4,8 . Kidney transplant recipients were divided into two groups as DGF group and non­DGF group. The donor organs were derived from cadaveric donation of brain-dead donors, and each case of brain-dead donors received informed consent from their families and approval from the Ethics Committee for civic organ donation. This study was conducted with the informed consent of kidney transplant recipients, in strict compliance with the ethical requirements of medical clinical research, and was approved by the Clinical Research and Application Ethics Committee of the Second Affiliated Hospital of Guangzhou Medical University, number 2024-hg-ks-46. Electronic medical records for positive CMV test results, including viral cultures, histopathology, and viral load testing. All transplantations in patients aged ≥18 years who underwent kidney transplantation from January 2020 to November 2023 were eligible to be included. The inclusion criteria were (1) grafts obtained from deceased donation, (2) surgery performed as single-kidney transplantation, (3) and patients with complete data. Immunosuppressive Regimens Rituximab, antithymocyte globulin or interleukin 2 receptor antibody blockers with steroids were used as induction therapy based on immunologic risk factors. Our standard maintenance immunosuppressive protocol included with a calcineurin inhibitor, an antimetabolite, and prednisone. CMV Prophylaxis and Diagnosis During the study period, only CMV-seronegative patients receiving a kidney from a seropositive donor (D+/R-) were initiated on prophylactic ganciclovir 500 mg 3 times daily, or oral valganciclovir 450 mg once daily during the first 180 days after transplantation. Dose adjustments for renal impairment were based on drug use manual. The incidence of CMV disease defined as clinical signs of CMV infection confirmed with a positive CMV quantitative polymerase chain reaction (>1000 copies/mL), was studied. Viralload assessment of CMV below laboratory detection limit were not included in the analysis. Cytomegalovirus pneumonia were defined by detailed clinical evidence of infection (fever, cough with or without sputum, chest distress, dyspnea, and hypoxemia) with definitive bronchoalveolar lavage results of fluorescence quantitative PCR. Statistical Analysis Statistical analyses were performed by SPSS software version 26.0 (IBM SPSS Statistics, Chicago, Illinois, USA). Data were presented as median (range) and number (%). Categorical variables among patient groups were compared using the chi-square and Fisher’s exact tests, and continuous variables were compared using the the unpaired t-test and Mann–Whitney U test. Binary logistic regression was performed to assess the impact of significant DGF-related factors in univariate analysis. We considered p-value less than 0.05 as the significance level in all associations and analyses. Results One hundred and twenty-four kidney transplant recipients (35 females, 89 males) were included in this study. The average age of the patients was 44.72±9.97 years. Of the kidney transplant recipients, 60 were DGF and 64 were without DGF. Glomerulonephritis was the most common cause leading to end-stage renal disease (58.05%), followed by diabetes mellitus (10.55%) and chronic renal failure of unknown origin (31.4%). Initial standard immunosuppression was usually performed with a triple-drug regimen including cyclosporine (n=14, 11.29%) or tacrolimus (n=110, 88.71%) combined with mycophenolate mofetil and prednisone. Baseline characteristics of the study population are shown in Table 1 . Table 2 shows the posttransplant complication rates in DGF and without DGF recipients. Five patients without DGF occurred kidney allograft rejection. Four patients occurred in the DGF group and did not differ significantly between the two groups (P=0.806). The incidence of cytomegaloviruria during 1 year after transplantation was higher in patients with DGF (12/60), compared to patients without DGF (4/64). This difference was statistically significant ( p = 0.022). No statistically significant difference was found between the groups regarding urinary tract infection (p=0.633). The groups were found similar concerning cytomegalovirus viremia (p=0.443) and cytomegalovirus pneumonia (p=0.677). Data from multivariate logistic regression analysis are shown in Table 3 . In the multivariate analysis, only DGF (P=0.0226< 0.05; OR, 4.34) was an independent risk factor for the development of cytomegaloviruria. Based on the results, we further explore the immune status between the two groups. Lymphocyte proportion and CD4+ T cells absolute counts were significantly higher in patients without DGF than in patients with DGF (p= 0.031 and p=0.012). Other immune factors did not differ remarkably between the two groups ( Table 4 ). Discussion DGF is a common immediate postoperative complication after renal transplantation. In this single center study of 124 renal transplant recipients, we aimed to evaluate the risk of CMV infection in patients with DGF after kidney transplantation. The results of our study in kidney transplantation recipients showed that a higher percentage of cytomegaloviruria was observed in DGF patients. In addition, lymphocyte proportion and CD4 + T cells absolute counts of the DGF group were lower than those of without DGF group. DGF is a common complication in kidney transplantation and is related to short- and long-term graft outcomes 9 , 10 . In recent years, the incidence of DGF has increased with an incidence rate ranging between 20% and 45% because of the use of kidney allografts from expanded criteria donors 11 – 13 . DGF is a major obstacle for allograft survival as it can be compounded by acute rejection and acute kidney injury. In a 3-year, donation after cardiac death kidney registry analysis, Lim et al. 5 reported that recipients of donation after cardiac death kidneys with DGF experienced a higher incidence of overall and death-censored graft loss compared with those without DGF. A meta-analysis of 34 studies from 1988 through 2007 concluded that patients with DGF had a 41% increased risk of graft loss at 3.2 years of follow-up 14 . CMV infection is common in the patients. When the immune system is weakened, CMV can be activationed immediately. Especially people who have had an organ, stem cell or bone marrow transplant, CMV infection can be fatal. CMV virus replication can occur locally in the affected organ compartment and can be detected by molecular viral load testing in the blood. The key points of successful treatment for CMV infection is the combination of early aggressive reduction of the immunosuppressive therapy. To the best of our knowledge, the relationship between DGF and CMV infection is still unclear in kidney transplantation recipients. In a large population study, the findings suggested that DGF was independent risk factors for developing CMV disease during the first three months after transplantation 15 . Kleinherenbrink et al 7 recently summarized and analyzed the data from 1300 renal transplant recipients who underwent a kidney transplantation in the Radboud University Medical Center between 2004 and 2015. This study demonstrated that recipients with DGF are at increased CMV infection risk. DGF also considerably increased the AR risk 7 . In another study, Helanterä et al. 16 demonstrated that DGF predicted CMV recurrence in the logistic regression model analysis. However, Freedman et al. 17 did not find a higher rate of CMV infection in kidney transplantation recipients. In a retrospective study by Alshaikh et al, DGF was significantly associated with an increased risk of BK viremia and urinary tract infection but not cytomegalovirus viremia or pneumonia 18 . The underlying mechanism of how DGF contributes to CMV infection has not been fully elucidated. One might think that the higher incidence of CMV infection could be due to the higher incidence of rejection, and associated anti-rejection therapy in patients with DGF. The acute tubular necrosis is a major determinant of renal ischemia-reperfusion injury and subsequent renal function, predisposing DGF 19 . DGF is known to be associated with innate immune responses, with complement activation and release of damage-associated molecular patterns, and with a higher incidence of rejection 20 . A second possibility is explained by underexposure to ganciclovir, resulting from dose adjustments because of impaired renal function and bone marrow depression. Finally, The overall degree of immunosuppression is thought to be the most important factor. Low T cell subsets absolute counts may be regarded as a potential risk factor for developing opportunistic infections 21 . This is consistent with our result what we show that lymphocyte proportion and CD4 + T cells absolute counts were significantly lower in patients with DGF. Our study has some limitations. A limitation of this study is the relatively small size of single-center retrospective cohort and the low incidence of CMV disease. Another limitation of our study is the lack of information of ganciclovir levels in this population. Moreover, we were unable to analyzed the association between DGF and cytomegalovirus viremia and cytomegalovirus pneumonia, the accurate mechanism is obscure. In future, the association between DGF and CMV infection should be evaluated in a prospective study with a larger sample size. Conclusion This study demonstrated that renal transplant recipients with DGF are at increased cytomegaloviruria risk. In addition, lymphocyte proportion and CD4 + T cells absolute counts were significantly lower in patients with DGF. The results suggest that CMV should be monitored following the diagnosis and treatment of DGF in renal transplant recipients. Declarations Acknowledgements Not applicable. Disclosures All authors declare that they have no conflict of interests. Funding The trial is supported by Medical Scientific Research Foundation of Guangdong Province of China（A2022250） and Science and Technology Program of Guangzhou of China（2024A03J0191）. The funding body has no role in the design of the study and collection, analysis, and interpretation of data nor in writing the manuscript. Contributions Luhao Liu and Rongxin Chen drafted the original manuscript. Luhao Liu is the lead investigator who designed the trial, and is responsible for sequential randomization of participants and oversight of data collection and analysis. Guanghui Li is responsible for reporting significant protocol modifications to the trial registry. Rongxin Chen is the lead biostatistician. All authors will have access to the final trial dataset. Zheng Chen will be responsible for dissemination of de-identified study results at professional meetings and through research publications. Zheng Chen co-authors are individuals who participated in study design and/or participant enrollment. All authors contributed edits, reviewed and approved the final manuscript. Authors’ information Not applicable. Ethics declarations This study was conducted with the informed consent of kidney transplant recipients, in strict compliance with the ethical requirements of medical clinical research, and was approved by the Clinical Research and Application Ethics Committee of the Second Affiliated Hospital of Guangzhou Medical University, number 2024-hg-ks-46. Informed written consent is required for participation in the clinical trial. Consent for publication Not applicable. Competing interests All authors declare that they have no competing interests. References Razonable RR, Humar A. Cytomegalovirus in solid organ transplant recipients-Guidelines of the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019;33(9):e13512. Lee YM, Kim YH, Han DJ, Park SK, Park JS, Sung H, Hong HL, Kim T, Kim SH, Choi SH and others. Cytomegalovirus infection after acute rejection therapy in seropositive kidney transplant recipients. Transpl Infect Dis 2014;16(3):397-402. Belga S, Hernandez C, Kabbani D, Cervera C. Incidence of valganciclovir-related leukopenia and neutropenia in solid organ transplant recipients at high risk of cytomegalovirus disease. Transpl Infect Dis 2024;26(2):e14227. Mallon DH, Summers DM, Bradley JA, Pettigrew GJ. Defining delayed graft function after renal transplantation: simplest is best. Transplantation 2013;96(10):885-9. Lim WH, McDonald SP, Russ GR, Chapman JR, Ma MK, Pleass H, Jaques B, Wong G. Association Between Delayed Graft Function and Graft Loss in Donation After Cardiac Death Kidney Transplants-A Paired Kidney Registry Analysis. Transplantation 2017;101(6):1139-1143. Bahl D, Haddad Z, Datoo A, Qazi YA. Delayed graft function in kidney transplantation. Curr Opin Organ Transplant 2019;24(1):82-86. Shahmirzadi MR, Gunaratnam L, Jevnikar AM, Luke P, House AA, Silverman MS, Hosseini-Moghaddam SM. The effect of late-onset CMV infection on the outcome of renal allograft considering initial graft function. Transpl Infect Dis 2023;25(4):e14081. Phillips BL, Ibrahim M, Greenhall G, Mumford L, Dorling A, Callaghan CJ. Effect of delayed graft function on longer-term outcomes after kidney transplantation from donation after circulatory death donors in the United Kingdom: A national cohort study. Am J Transplant 2021;21(10):3346-3355. Siedlecki A, Irish W, Brennan DC. Delayed graft function in the kidney transplant. Am J Transplant 2011; 11(11):2279-96. Budhiraja P, Reddy KS, Butterfield RJ, Jadlowiec CC, Moss AA, Khamash HA, et al. Duration of delayed graft function and its impact on graft outcomes in deceased donor kidney transplantation. Bmc Nephrol. 2022;23(1):154. Willicombe M, Rizzello A, Goodall D, Papalois V, McLean AG, Taube D. Risk factors and outcomes of delayed graft function in renal transplant recipients receiving a steroid sparing immunosuppression protocol. World J Transplant. 2017;7(1):34-42. Chen R, Wang H, Song L, Hou J, Peng J, Dai H, et al. Predictors and one-year outcomes of patients with delayed graft function after deceased donor kidney transplantation. Bmc Nephrol. 2020;21(1):526. Jahn L, Rüster C, Schlosser M, Winkler Y, Foller S, Grimm MO, et al. Rate, Factors, and Outcome of Delayed Graft Function After Kidney Transplantation of Deceased Donors. Transpl P. 2021;53(5):1454-61. Yarlagadda SG, Coca SG, Formica RJ, Poggio ED, Parikh CR. Association between delayed graft function and allograft and patient survival: a systematic review and meta-analysis. Nephrol Dial Transpl. 2009;24(3):1039-47. Kleinherenbrink W, Baas M, Nakhsbandi G, Hesselink DA, Roodnat JI, de Winter BC, et al. Delayed graft function and rejection are risk factors for cytomegalovirus breakthrough infection in kidney transplant recipients. Pharmacol Res. 2021;167:105565. Helanterä I, Lautenschlager I, Koskinen P. The risk of cytomegalovirus recurrence after kidney transplantation. Transpl Int. 2011;24(12):1170-8. Freedman SR, Ravichandran BR, Masters BM, Bromberg JS, Haririan A, Saharia KK, et al. Clinical outcomes of valganciclovir prophylaxis in high-risk (D+/R-) renal transplant recipients experiencing delayed graft function. Transpl Infect Dis. 2019;21(4):e13125. Alshaikh EA, Astor BC, Muth B, Jorgenson M, Swanson K, Garg N, et al. Delayed Graft Function Among Kidney Transplant Recipients Is Associated With an Increased Risk of Urinary Tract Infection and BK Viremia. Transplant Direct. 2023;9(9):e1526. Mikhalski D, Wissing KM, Ghisdal L, Broeders N, Touly M, Hoang AD, et al. Cold ischemia is a major determinant of acute rejection and renal graft survival in the modern era of immunosuppression. Transplantation. 2008;85(7 Suppl):S3-9. Mannon RB. Delayed Graft Function: The AKI of Kidney Transplantation. Nephron. 2018;140(2):94-8. van Doesum WB, Abdulahad WH, van Dijk MC, Dolff S, van Son WJ, Stegeman CA, et al. Characterization of urinary CD4⁺ and CD8⁺ T cells in kidney transplantation patients with polyomavirus BK infection and allograft rejection. Transpl Infect Dis. 2014;16(5):733-43. Tables Table 1 - General characteristics of the population, according to the presence or absence of DGF. Characteristics Without DGF (n = 64) With DGF (n = 60) P Value Gender, n (%) Male 48 (75.0) 41 (68.3) 0.410 Female 16 (25.0) 19 (31.7) Age, years 44.11±10.76 45.37±9.09 0.485 Body mass index, kg/m 2 23.64±3.10 24.21±3.57 0.344 Primary cause of renal failure glomerulonephritis 38 (59.4) 34 (56.7) 0.601 diabetes 5 (7.8) 8 (13.3) other 21 (32.8) 18 (30.0) HLA mismatches >3, n (%) 14(21.9) 9(15.0) 0.464 PRA level, n (%) Positive 5(7.8) 7(11.7) 0.468 Negative 59(92.2) 53(88.3) duration of dialysis 35.05±17.93 33.05±18.31 0.541 dialysis modalitiy non-dialysis 3(4.7) 2(3.3) 0.921 hemodialysis 51(79.7) 49(81.7) peritoneal dialysis 10(15.6) 9(15.0) Serum creatinine before discharge 167.27±39.87 170.52±32.81 0.622 History of hypotension, n (%) Yes 61(95.3) 58(96.7) 0.702 No 3(4.7) 2(3.3) History of diabetes, n (%) Yes 9(14.1) 5(8.3) 0.314 No 55(85.9) 55(91.7) Immunosuppressive agents Cyclosporine 8(12.5) 6(10.0) 0.660 Tacrolimus 56(87.5) 54(90.0) Table 2. Analysis of complications in two groups of patients after kidney transplantation. Without DGF (n = 64) With DGF (n = 60) P Value acute rejection 5 4 0.806 urinary tract infection 3 4 0.633 cytomegaloviruria 4 12 0.022 cytomegalovirus viremia 4 6 0.443 cytomegalovirus pneumonia 6 7 0.677 Table 3. Multivariable Cox proportional hazards model of risk factors for cytomegalovirus infection after kidney transplantation. Characteristics cytomegaloviruria cytomegalovirus viremia cytomegalovirus pneumonia OR（95%CI） Adjusted OR（95%CI） OR（95%CI） Adjusted OR（95%CI） OR（95%CI） Adjusted OR（95%CI） Gender 1.21(0.36, 4.03) 1.41(0.36, 5.43) 1.63(0.33, 8.08) 2.13 (0.34, 13.28) 5.30(0.66, 42.39) 6.31(0.74, 53.78) Age 0.99(0.94, 1.05) 0.99(0.93, 1.06) 1.01 (0.94, 1.07) 1.02 (0.94, 1.10) 0.99(0.94, 1.06) 1.02(0.96, 1.09) BMI 1.01(0.86, 1.17) 0.99(0.83, 1.20) 1.02(0.84, 1.23) 0.93(0.72, 1.19) 0.90(0.74, 1.09) 0.86(0.69, 1.07) Primary cause of renal failure 0.78(0.42, 1.44) 0.88(0.43, 1.79) 0.48 (0.18, 1.27) 0.35 (0.09, 1.28) 0.95(0.50, 1.79) 0.99(0.48, 2.78) HLA mismatches 0.92(0.59, 1.43) 0.99(0.59, 1.66) 1.36(0.78, 2.35) 1.44(0.75, 2.78) 1.07(0.66, 1.74) 1.24(0.69, 2.24) PRA level 1.70(0.21, 14.15) 2.41(0.25, 23.03) - - 1.32(0.16, 11.14) 1.82(0.17, 19.01) duration of dialysis 1.01(0.97, 1.03) 0.99(0.97, 1.03) 0.99(0.96, 1.03) 1.01(0.97, 1.05) 0.86(0.69, 1.07) 1.01(0.97, 1.04) dialysis modalitiy 1.57(0.48, 5.14) 1.54(0.42, 5.72) 0.48(0.09, 2.46) 0.53(0.08, 3.49) 1.28(0.34, 4.77) 1.12(0.29, 4.39) Serum creatinine before discharge 0.99(0.98, 1.01) 0.99(0.98, 1.01) 1.02(1.00, 1.03) 1.01(0.99, 1.04) 0.99(0.98, 1.01) 0.99(0.98, 1.02) History of hypotension 0.58(0.06, 5.51) 0.62(0.05, 8.22) - - 0.45(0.05, 4.35) 0.44(0.03, 5.87) History of diabetes 0.49(0.06, 4.00) 1.26(0.12, 12.96) - - 0.63(0.08, 5.24) 0.61(0.06, 6.16) Immunosuppressive agents - - 2.13(0.40, 11.19) 3.91(0.43, 35.49) 0.63(0.07, 5.24) 0.62(0.06, 6.52) DGF 3.75 (1.14, 12.37) 4.34 (1.20, 15.72) 1.67(0.45, 6.22) 3.22 (0.60, 17.40) 1.28(0.40, 4.04) 1.59(0.45, 5.64) Table 4. The differences of cellular immunity between the two groups. Immune status Without DGF (n = 64) With DGF (n = 60) P Value lymphocyte proportion (%) 22.93±5.58 20.88±4.87 0.031 lymphocytic absolute value (10 9 /L) 1.81±0.60 1.76±0.57 0.635 CD3+ T cells absolute counts (cells/μL) 1931±552 1982±486 0.589 CD4+ T cells absolute counts (cells/μL) 867±257 743±284 0.012 CD8+ T cells absolute counts (cells/μL) 655±270 570±268 0.083 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5886297","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":414697273,"identity":"638299c8-df31-4414-9494-1d3ef76eeea2","order_by":0,"name":"Luhao Liu","email":"","orcid":"","institution":"Second Affiliated Hospital of Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Luhao","middleName":"","lastName":"Liu","suffix":""},{"id":414697274,"identity":"7d484108-e231-44aa-a65a-f994f92b0b9e","order_by":1,"name":"Rongxin Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuklEQVRIiWNgGAWjYHACNiCWkONnZj78gBQtNsaS7WxpBqRoSUvccJ5HQYIo9eYzkp89+LjjcOLmwzwMBgw1NtEEtcicOWZuOPPMYeNth3kPPGA4lpbbQEiLBHsPmzRv22HZbYf5EgwYGw4ToYWZh036b9thxs3NPAYSxGkB2cLYlqa4gZloLTzHzCR722yMJQ4DAzmBKL9IJD+T+NkGjMr+w4cffKixIawFFSSQpnwUjIJRMApGAS4AAC3vOj2uZy4XAAAAAElFTkSuQmCC","orcid":"","institution":"Second Affiliated Hospital of Guangzhou Medical University","correspondingAuthor":true,"prefix":"","firstName":"Rongxin","middleName":"","lastName":"Chen","suffix":""},{"id":414697275,"identity":"7fc4e213-35ca-459c-9540-ea93e4ed8850","order_by":2,"name":"Jiali Cai","email":"","orcid":"","institution":"Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Jiali","middleName":"","lastName":"Cai","suffix":""},{"id":414697276,"identity":"abfa3b02-ef09-405e-9e3a-05dc21e730f0","order_by":3,"name":"Maierheba Wubuli","email":"","orcid":"","institution":"Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Maierheba","middleName":"","lastName":"Wubuli","suffix":""},{"id":414697277,"identity":"6342e711-d638-4a60-8df7-36a7d57e108f","order_by":4,"name":"Boyu Zheng","email":"","orcid":"","institution":"Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Boyu","middleName":"","lastName":"Zheng","suffix":""},{"id":414697278,"identity":"703a33fd-1e68-4d73-aed6-18804f785891","order_by":5,"name":"Junhan Wang","email":"","orcid":"","institution":"Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Junhan","middleName":"","lastName":"Wang","suffix":""},{"id":414697279,"identity":"785c6a19-0f0e-458e-9c80-34c77ab162c7","order_by":6,"name":"Xiangyou Li","email":"","orcid":"","institution":"Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiangyou","middleName":"","lastName":"Li","suffix":""},{"id":414697280,"identity":"2981767b-d45b-4fd2-8f78-984defd90010","order_by":7,"name":"Yujing Lin","email":"","orcid":"","institution":"Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yujing","middleName":"","lastName":"Lin","suffix":""},{"id":414697281,"identity":"c18c6fda-e88a-4d90-9189-698677af2f04","order_by":8,"name":"Zheng Chen","email":"","orcid":"","institution":"Second Affiliated Hospital of Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zheng","middleName":"","lastName":"Chen","suffix":""},{"id":414697282,"identity":"1f25e5ef-a571-45eb-b1f7-27e35abd5897","order_by":9,"name":"Guanghui Li","email":"","orcid":"","institution":"Second Affiliated Hospital of Guangzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Guanghui","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2025-01-23 08:08:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5886297/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5886297/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":78227977,"identity":"6a36a290-a441-430f-9876-db012a0c0c76","added_by":"auto","created_at":"2025-03-11 07:09:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":618922,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5886297/v1/8f029486-07aa-4c16-b41c-8f90a4a97a77.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association Between Delayed Graft Function and Cytomegalovirus Infection after Renal Transplant","fulltext":[{"header":"Background","content":"\u003cp\u003eCytomegalovirus (CMV) infection was one of the main viral infectious complication in solid organ transplant recipients. CMV remain in the body indefinitely, and may have an indirect effects on secondary infections, malignancy, and overall decreased graft and patient survival \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Several factors have been found to increase the risk of CMV reactivation, such as an CMV seropositive donor, the use of antilymphocyte-based immunosuppression and the presence of T-cell mediated rejection \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDelayed graft function (DGF), defined as the need for dialysis within 7 days after kidney transplantation, occurs in 25\u0026ndash;30% of deceased donor renal transplantations in the US\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. The etiology of DGF includes ischemia-reperfusion injury, acute rejection, thrombotic microangiopathy, vascular and surgical complications\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. DGF has no curative treatment, and patients with DGF frequently receive augmented immunosuppression due to the risk of hyperacute rejection\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Therefore, patients with DGF may be at higher risk for CMV infection because of allograft injury and augmented immunosuppressive strategies. The association between DGF and CMV infection are still under investigation. In this study we aimed to evaluate the risk of CMV infection in patients with DGF after kidney transplantation, using our registry data.\u003c/p\u003e"},{"header":"Material and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a single center, retrospective, cohort study assessed CMV infection outcomes in renal transplant recipients receiving prophylaxis with valganciclovir and experiencing DGF. DGF was defined as the need for dialysis within 1 week after kidney transplantation\u003csup\u003e4,8\u003c/sup\u003e. Kidney transplant recipients were divided into two groups as DGF group and non\u0026shy;DGF group. The donor organs were derived from cadaveric donation of brain-dead donors, and each case of brain-dead donors received informed consent from their families and approval from the Ethics Committee for civic organ donation. This study was conducted with the informed consent of kidney transplant recipients, in strict compliance with the ethical requirements of medical clinical research, and was approved by the Clinical Research and Application Ethics Committee of the Second Affiliated Hospital of Guangzhou Medical University, number 2024-hg-ks-46.\u003c/p\u003e\n\u003cp\u003eElectronic medical records for positive CMV test results, including viral cultures, histopathology, and viral load testing. All transplantations in patients aged\u0026nbsp;\u0026ge;18 years who underwent kidney transplantation from January 2020 to November 2023 were eligible to be included. The inclusion criteria were (1) grafts obtained from deceased donation, (2) surgery performed as single-kidney transplantation, (3) and patients with complete data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImmunosuppressive Regimens\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRituximab, antithymocyte globulin or interleukin 2 receptor antibody blockers with steroids were used as induction therapy based on immunologic risk factors. Our standard maintenance immunosuppressive protocol included with a calcineurin inhibitor, an antimetabolite, and prednisone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCMV Prophylaxis and Diagnosis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the study period, only CMV-seronegative patients receiving a kidney from a seropositive donor (D+/R-) were initiated on prophylactic ganciclovir 500 mg 3 times daily, or oral valganciclovir 450 mg once daily during the first 180 days after transplantation. Dose adjustments for renal impairment were based on drug use manual. The incidence of CMV disease defined as clinical signs of CMV infection confirmed with a positive CMV quantitative polymerase chain reaction (\u0026gt;1000 copies/mL), was studied. Viralload assessment of CMV below laboratory detection limit were not included in the analysis. Cytomegalovirus pneumonia were defined by detailed clinical evidence of infection (fever, cough with or without sputum, chest distress, dyspnea, and hypoxemia) with definitive bronchoalveolar lavage results of fluorescence quantitative PCR.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analyses were performed by SPSS software version 26.0 (IBM SPSS Statistics, Chicago, Illinois, USA). Data were presented as median (range) and number (%). Categorical variables among patient groups were compared using the chi-square and Fisher\u0026rsquo;s exact tests, and continuous variables were compared using the \u0026nbsp;the unpaired t-test and Mann\u0026ndash;Whitney U test. Binary logistic regression was performed to assess the impact of significant DGF-related factors in univariate analysis. We considered p-value less than 0.05 as the significance level in all associations and analyses.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOne hundred and twenty-four kidney transplant recipients (35 females, 89 males) were included in this study. The average age of the patients was 44.72\u0026plusmn;9.97 years. Of the kidney transplant recipients, 60 were DGF and 64 were without DGF. \u0026nbsp;Glomerulonephritis was the most common cause leading to end-stage renal disease (58.05%), followed by diabetes mellitus (10.55%) and chronic renal failure of unknown origin (31.4%). Initial standard immunosuppression was usually performed with a triple-drug regimen including cyclosporine (n=14, 11.29%) or tacrolimus (n=110, 88.71%) combined with mycophenolate mofetil and prednisone. Baseline characteristics of the study population are shown in\u0026nbsp;\u003cstrong\u003eTable 1\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e shows the posttransplant complication rates in DGF and without DGF recipients. Five patients without DGF occurred kidney allograft rejection. Four patients occurred in the DGF group and did not differ significantly between the two groups (P=0.806). The incidence of cytomegaloviruria during 1 year after transplantation was higher in patients with DGF (12/60), compared to patients without DGF (4/64). This difference was statistically significant ( p = 0.022). No statistically significant difference was found between the groups regarding urinary tract infection (p=0.633). The groups were found similar concerning cytomegalovirus viremia (p=0.443) and cytomegalovirus pneumonia (p=0.677).\u003c/p\u003e\n\u003cp\u003eData from multivariate logistic regression analysis are shown in\u0026nbsp;\u003cstrong\u003eTable 3\u003c/strong\u003e. In the multivariate analysis, only DGF (P=0.0226\u0026lt; 0.05; OR, 4.34) was an independent risk factor for the development of cytomegaloviruria. Based on the results, we further explore the immune status between the two groups. Lymphocyte proportion and CD4+ T cells absolute counts were significantly higher in patients without DGF than in patients with DGF (p= 0.031 and p=0.012). Other immune factors did not differ remarkably between the two groups (\u003cstrong\u003eTable 4\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDGF is a common immediate postoperative complication after renal transplantation. In this single center study of 124 renal transplant recipients, we aimed to evaluate the risk of CMV infection in patients with DGF after kidney transplantation. The results of our study in kidney transplantation recipients showed that a higher percentage of cytomegaloviruria was observed in DGF patients. In addition, lymphocyte proportion and CD4\u0026thinsp;+\u0026thinsp;T cells absolute counts of the DGF group were lower than those of without DGF group.\u003c/p\u003e \u003cp\u003eDGF is a common complication in kidney transplantation and is related to short- and long-term graft outcomes\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. In recent years, the incidence of DGF has increased with an incidence rate ranging between 20% and 45% because of the use of kidney allografts from expanded criteria donors\u003csup\u003e\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. DGF is a major obstacle for allograft survival as it can be compounded by acute rejection and acute kidney injury. In a 3-year, donation after cardiac death kidney registry analysis, Lim et al. \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e reported that recipients of donation after cardiac death kidneys with DGF experienced a higher incidence of overall and death-censored graft loss compared with those without DGF. A meta-analysis of 34 studies from 1988 through 2007 concluded that patients with DGF had a 41% increased risk of graft loss at 3.2 years of follow-up\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eCMV infection is common in the patients. When the immune system is weakened, CMV can be activationed immediately. Especially people who have had an organ, stem cell or bone marrow transplant, CMV infection can be fatal. CMV virus replication can occur locally in the affected organ compartment and can be detected by molecular viral load testing in the blood. The key points of successful treatment for CMV infection is the combination of early aggressive reduction of the immunosuppressive therapy.\u003c/p\u003e \u003cp\u003eTo the best of our knowledge, the relationship between DGF and CMV infection is still unclear in kidney transplantation recipients. In a large population study, the findings suggested that DGF was independent risk factors for developing CMV disease during the first three months after transplantation\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Kleinherenbrink et al\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e recently summarized and analyzed the data from 1300 renal transplant recipients who underwent a kidney transplantation in the Radboud University Medical Center between 2004 and 2015. This study demonstrated that recipients with DGF are at increased CMV infection risk. DGF also considerably increased the AR risk\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. In another study, Helanter\u0026auml; et al.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e demonstrated that DGF predicted CMV recurrence in the logistic regression model analysis. However, Freedman et al.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003edid not find a higher rate of CMV infection in kidney transplantation recipients. In a retrospective study by Alshaikh et al, DGF was significantly associated with an increased risk of BK viremia and urinary tract infection but not cytomegalovirus viremia or pneumonia \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe underlying mechanism of how DGF contributes to CMV infection has not been fully elucidated. One might think that the higher incidence of CMV infection could be due to the higher incidence of rejection, and associated anti-rejection therapy in patients with DGF. The acute tubular necrosis is a major determinant of renal ischemia-reperfusion injury and subsequent renal function, predisposing DGF\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. DGF is known to be associated with innate immune responses, with complement activation and release of damage-associated molecular patterns, and with a higher incidence of rejection\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. A second possibility is explained by underexposure to ganciclovir, resulting from dose adjustments because of impaired renal function and bone marrow depression. Finally, The overall degree of immunosuppression is thought to be the most important factor. Low T cell subsets absolute counts may be regarded as a potential risk factor for developing opportunistic infections\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. This is consistent with our result what we show that lymphocyte proportion and CD4\u0026thinsp;+\u0026thinsp;T cells absolute counts were significantly lower in patients with DGF.\u003c/p\u003e \u003cp\u003eOur study has some limitations. A limitation of this study is the relatively small size of single-center retrospective cohort and the low incidence of CMV disease. Another limitation of our study is the lack of information of ganciclovir levels in this population. Moreover, we were unable to analyzed the association between DGF and cytomegalovirus viremia and cytomegalovirus pneumonia, the accurate mechanism is obscure. In future, the association between DGF and CMV infection should be evaluated in a prospective study with a larger sample size.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrated that renal transplant recipients with DGF are at increased cytomegaloviruria risk. In addition, lymphocyte proportion and CD4\u0026thinsp;+\u0026thinsp;T cells absolute counts were significantly lower in patients with DGF. The results suggest that CMV should be monitored following the diagnosis and treatment of DGF in renal transplant recipients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare that they have no conflict of interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe trial is supported by Medical Scientific Research Foundation of Guangdong Province of China（A2022250）\u0026nbsp;and Science and Technology Program of Guangzhou of China（2024A03J0191）. The funding body has no role in the design of the study and collection, analysis, and interpretation of data nor in writing the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLuhao Liu\u0026nbsp;and Rongxin Chen drafted the original manuscript. Luhao Liu is the lead investigator who designed the trial, and is responsible for sequential randomization of participants and oversight of data collection and analysis. Guanghui Li is responsible for reporting significant protocol modifications to the trial registry. Rongxin Chen is the lead biostatistician. All authors will have access to the final trial dataset. Zheng Chen will be responsible for dissemination of de-identified study results at professional meetings and through research publications. Zheng Chen co-authors are individuals who participated in study design and/or participant enrollment. All authors contributed edits, reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted with the informed consent of kidney transplant recipients, in strict compliance with the ethical requirements of medical clinical research, and was approved by the Clinical Research and Application Ethics Committee of the Second Affiliated Hospital of Guangzhou Medical University, number 2024-hg-ks-46. Informed written consent is required for participation in the clinical trial.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eRazonable RR, Humar A. Cytomegalovirus in solid organ transplant recipients-Guidelines of the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019;33(9):e13512.\u003c/li\u003e\n \u003cli\u003eLee YM, Kim YH, Han DJ, Park SK, Park JS, Sung H, Hong HL, Kim T, Kim SH, Choi SH and others. Cytomegalovirus infection after acute rejection therapy in seropositive kidney transplant recipients. Transpl Infect Dis 2014;16(3):397-402.\u003c/li\u003e\n \u003cli\u003eBelga S, Hernandez C, Kabbani D, Cervera C. Incidence of valganciclovir-related leukopenia and neutropenia in solid organ transplant recipients at high risk of cytomegalovirus disease. Transpl Infect Dis 2024;26(2):e14227.\u003c/li\u003e\n \u003cli\u003eMallon DH, Summers DM, Bradley JA, Pettigrew GJ. Defining delayed graft function after renal transplantation: simplest is best. Transplantation 2013;96(10):885-9.\u003c/li\u003e\n \u003cli\u003eLim WH, McDonald SP, Russ GR, Chapman JR, Ma MK, Pleass H, Jaques B, Wong G. Association Between Delayed Graft Function and Graft Loss in Donation After Cardiac Death Kidney Transplants-A Paired Kidney Registry Analysis. Transplantation 2017;101(6):1139-1143.\u003c/li\u003e\n \u003cli\u003eBahl D, Haddad Z, Datoo A, Qazi YA. Delayed graft function in kidney transplantation. Curr Opin Organ Transplant 2019;24(1):82-86.\u003c/li\u003e\n \u003cli\u003eShahmirzadi MR, Gunaratnam L, Jevnikar AM, Luke P, House AA, Silverman MS, Hosseini-Moghaddam SM. The effect of late-onset CMV infection on the outcome of renal allograft considering initial graft function. Transpl Infect Dis 2023;25(4):e14081.\u003c/li\u003e\n \u003cli\u003ePhillips BL, Ibrahim M, Greenhall G, Mumford L, Dorling A, Callaghan CJ. Effect of delayed graft function on longer-term outcomes after kidney \u0026nbsp;transplantation from donation after circulatory death donors in the United \u0026nbsp; Kingdom: A national cohort study. Am J Transplant 2021;21(10):3346-3355.\u003c/li\u003e\n \u003cli\u003eSiedlecki A, Irish W, Brennan DC. Delayed graft function in the kidney transplant. Am J Transplant 2011; 11(11):2279-96.\u003c/li\u003e\n \u003cli\u003eBudhiraja P, Reddy KS, Butterfield RJ, Jadlowiec CC, Moss AA, Khamash HA, et al. Duration of delayed graft function and its impact on graft outcomes in deceased \u0026nbsp;donor kidney transplantation. Bmc Nephrol. 2022;23(1):154.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWillicombe M, Rizzello A, Goodall D, Papalois V, McLean AG, Taube D. Risk factors and outcomes of delayed graft function in renal transplant recipients receiving a steroid sparing immunosuppression protocol. World J Transplant. 2017;7(1):34-42.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eChen R, Wang H, Song L, Hou J, Peng J, Dai H, et al. Predictors and one-year outcomes of patients with delayed graft function after deceased donor kidney transplantation. Bmc Nephrol. 2020;21(1):526.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eJahn L, R\u0026uuml;ster C, Schlosser M, Winkler Y, Foller S, Grimm MO, et al. Rate, Factors, and Outcome of Delayed Graft Function After Kidney Transplantation of Deceased Donors. Transpl P. 2021;53(5):1454-61.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eYarlagadda SG, Coca SG, Formica RJ, Poggio ED, Parikh CR. Association between delayed graft function and allograft and patient survival: a systematic review and meta-analysis. Nephrol Dial Transpl. 2009;24(3):1039-47.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKleinherenbrink W, Baas M, Nakhsbandi G, Hesselink DA, Roodnat JI, de Winter BC, et al. Delayed graft function and rejection are risk factors for cytomegalovirus \u0026nbsp;breakthrough infection in kidney transplant recipients. Pharmacol Res. 2021;167:105565.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHelanter\u0026auml; I, Lautenschlager I, Koskinen P. The risk of cytomegalovirus recurrence after kidney transplantation. Transpl Int. 2011;24(12):1170-8.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eFreedman SR, Ravichandran BR, Masters BM, Bromberg JS, Haririan A, Saharia KK, et al. Clinical outcomes of valganciclovir prophylaxis in high-risk (D+/R-) renal \u0026nbsp;transplant recipients experiencing delayed graft function. Transpl Infect Dis. 2019;21(4):e13125.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eAlshaikh EA, Astor BC, Muth B, Jorgenson M, Swanson K, Garg N, et al. Delayed Graft Function Among Kidney Transplant Recipients Is Associated With an \u0026nbsp;Increased Risk of Urinary Tract Infection and BK Viremia. Transplant Direct. 2023;9(9):e1526.\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Mikhalski D, Wissing KM, Ghisdal L, Broeders N, Touly M, Hoang AD, et al. Cold ischemia is a major determinant of acute rejection and renal graft survival in the modern era of immunosuppression. Transplantation. 2008;85(7 Suppl):S3-9.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMannon RB. Delayed Graft Function: The AKI of Kidney Transplantation. Nephron. 2018;140(2):94-8.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003evan Doesum WB, Abdulahad WH, van Dijk MC, Dolff S, van Son WJ, Stegeman CA, et al. Characterization of urinary CD4⁺ and CD8⁺ T cells in kidney transplantation patients with polyomavirus BK infection and allograft rejection. Transpl Infect Dis. 2014;16(5):733-43.\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 - General characteristics of the population, according to the presence or absence of DGF.\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"592\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003eWithout DGF\u003c/p\u003e\n \u003cp\u003e(n = 64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003eWith DGF\u003c/p\u003e\n \u003cp\u003e(n = 60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003eP Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eGender, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e48 (75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e41 (68.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.410\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e16 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e19 (31.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003eAge, years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e44.11\u0026plusmn;10.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e45.37\u0026plusmn;9.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.485\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003eBody mass index, kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e23.64\u0026plusmn;3.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e24.21\u0026plusmn;3.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.344\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePrimary cause of renal failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eglomerulonephritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e38 (59.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e34 (56.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.601\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003ediabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e5 (7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e8 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e21 (32.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e18 (30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003eHLA mismatches \u0026gt;3, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e14(21.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e9(15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.464\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003ePRA level, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e5(7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e7(11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.468\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e59(92.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e53(88.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003eduration of dialysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e35.05\u0026plusmn;17.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e33.05\u0026plusmn;18.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.541\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003edialysis modalitiy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003enon-dialysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e3(4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e2(3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.921\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003ehemodialysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e51(79.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e49(81.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eperitoneal dialysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e10(15.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e9(15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 288px;\"\u003e\n \u003cp\u003eSerum creatinine before discharge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e167.27\u0026plusmn;39.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e170.52\u0026plusmn;32.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.622\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eHistory of hypotension, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e61(95.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e58(96.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.702\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e3(4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e2(3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eHistory of diabetes, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e9(14.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e5(8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.314\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e55(85.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e55(91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 145px;\"\u003e\n \u003cp\u003eImmunosuppressive agents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eCyclosporine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e8(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e6(10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.660\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eTacrolimus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 119px;\"\u003e\n \u003cp\u003e56(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e54(90.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 2. Analysis of complications in two groups of patients after kidney transplantation.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"593\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eWithout DGF\u003c/p\u003e\n \u003cp\u003e(n = 64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003eWith DGF\u003c/p\u003e\n \u003cp\u003e(n = 60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eP Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003eacute rejection\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.806\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003eurinary tract infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.633\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003ecytomegaloviruria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.022\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003ecytomegalovirus viremia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.443\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 187px;\"\u003e\n \u003cp\u003ecytomegalovirus pneumonia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 165px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.677\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 3. Multivariable Cox proportional hazards model of risk factors for cytomegalovirus infection after kidney transplantation.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"993\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Characteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 271px;\"\u003e\n \u003cp\u003ecytomegaloviruria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 279px;\"\u003e\n \u003cp\u003ecytomegalovirus viremia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003ecytomegalovirus pneumonia\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003eOR（95%CI）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eAdjusted OR（95%CI）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eOR（95%CI）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eAdjusted OR（95%CI）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eOR（95%CI）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003eAdjusted OR（95%CI）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e1.21(0.36, 4.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e1.41(0.36, 5.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e1.63(0.33, 8.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e2.13 (0.34, 13.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e5.30(0.66, 42.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e6.31(0.74, 53.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0.99(0.94, 1.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.99(0.93, 1.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e1.01 (0.94, 1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1.02 (0.94, 1.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e0.99(0.94, 1.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e1.02(0.96, 1.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e1.01(0.86, 1.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.99(0.83, 1.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e1.02(0.84, 1.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0.93(0.72, 1.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e0.90(0.74, 1.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e0.86(0.69, 1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003ePrimary cause of renal failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0.78(0.42, 1.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.88(0.43, 1.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e0.48 (0.18, 1.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0.35 (0.09, 1.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e0.95(0.50, 1.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e0.99(0.48, 2.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eHLA mismatches\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0.92(0.59, 1.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.99(0.59, 1.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e1.36(0.78, 2.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1.44(0.75, 2.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e1.07(0.66, 1.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e1.24(0.69, 2.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003ePRA level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e1.70(0.21, 14.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e2.41(0.25, 23.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e1.32(0.16, 11.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e1.82(0.17, 19.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eduration of dialysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e1.01(0.97, 1.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.99(0.97, 1.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e0.99(0.96, 1.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1.01(0.97, 1.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e0.86(0.69, 1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e1.01(0.97, 1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003edialysis modalitiy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e1.57(0.48, 5.14)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e1.54(0.42, 5.72)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e0.48(0.09, 2.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e0.53(0.08, 3.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e1.28(0.34, 4.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e1.12(0.29, 4.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eSerum creatinine before discharge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0.99(0.98, 1.01)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.99(0.98, 1.01)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e1.02(1.00, 1.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e1.01(0.99, 1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e0.99(0.98, 1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e0.99(0.98, 1.02)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eHistory of hypotension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0.58(0.06, 5.51)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.62(0.05, 8.22)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e0.45(0.05, 4.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e0.44(0.03, 5.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eHistory of diabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e0.49(0.06, 4.00)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e1.26(0.12, 12.96)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e0.63(0.08, 5.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e0.61(0.06, 6.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eImmunosuppressive agents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e2.13(0.40, 11.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e3.91(0.43, 35.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e0.63(0.07, 5.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e0.62(0.06, 6.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003eDGF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.75 (1.14, 12.37)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.34 (1.20, 15.72)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e1.67(0.45, 6.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e3.22 (0.60, 17.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e1.28(0.40, 4.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 160px;\"\u003e\n \u003cp\u003e1.59(0.45, 5.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4. The differences of cellular immunity between the two groups.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"606\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003eImmune status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003eWithout DGF\u003c/p\u003e\n \u003cp\u003e(n = 64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003eWith DGF\u003c/p\u003e\n \u003cp\u003e(n = 60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003eP Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003elymphocyte proportion (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e22.93\u0026plusmn;5.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e20.88\u0026plusmn;4.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.031\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003elymphocytic absolute value (10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e1.81\u0026plusmn;0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e1.76\u0026plusmn;0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.635\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003eCD3+ T cells absolute counts\u003c/p\u003e\n \u003cp\u003e(cells/\u0026mu;L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e1931\u0026plusmn;552\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e1982\u0026plusmn;486\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.589\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003eCD4+ T cells absolute counts\u003c/p\u003e\n \u003cp\u003e(cells/\u0026mu;L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e867\u0026plusmn;257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e743\u0026plusmn;284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.012\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 239px;\"\u003e\n \u003cp\u003eCD8+ T cells absolute counts\u003c/p\u003e\n \u003cp\u003e(cells/\u0026mu;L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 157px;\"\u003e\n \u003cp\u003e655\u0026plusmn;270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e570\u0026plusmn;268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cytomegalovirus, Delayed graft function, Kidney transplantation, Valganciclovir","lastPublishedDoi":"10.21203/rs.3.rs-5886297/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5886297/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Delayed graft function (DGF) increases the renal allograft failure risk. The objective of this study was to estimate the incidence of CMV infection and to analyze whether DGF is associated with an increased risk of CMV infection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This single center, retrospective, cohort study of deceased donor renal transplant recipients assessed CMV outcomes in patients experiencing DGF versus those without DGF. Univariate and multivariate hazard ratios were calculated with a Cox model.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Data from 124 recipients were evaluated (Mean age 44.72±9.97 years, 89 males). Cytomegaloviruria during 1 year after transplantation was diagnosed in 16 patients (12.9%). Patients with DGF were at a greater risk of cytomegaloviruria than patients without DGF (P=0.026). Furthermore, the lymphocyte proportion and CD4+ T cells absolute counts of the DGF group were lower than the without DGF group (p= 0.031 and p=0.012).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Our data support the hypothesis that renal transplant recipients with DGF are at increased risk of developing cytomegaloviruria. Prospective studies evaluating to monitor CMV viral loads and CD4+ T lymphocyte numbers in patients with DGF are needed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration：\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinical Research and Application Ethics Committee of the Second Affiliated Hospital of Guangzhou Medical University:2024-hg-ks-46.Registered 22 October 2024.\u003c/p\u003e","manuscriptTitle":"Association Between Delayed Graft Function and Cytomegalovirus Infection after Renal Transplant","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-14 08:09:05","doi":"10.21203/rs.3.rs-5886297/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c528f3b9-7d26-4803-abd7-4d2549ee02f3","owner":[],"postedDate":"February 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-11T07:08:59+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-14 08:09:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5886297","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5886297","identity":"rs-5886297","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}