Incidence of Cytomegalovirus (CMV) Infection in After Kidney Transplant Patients: A Systematic Review and Meta-Analysis.

Abstract

Kidney transplantation is recognised by the World Health Organisation as the most effective therapy for end-stage renal disease, offering substantial improvements in survival and quality of life. However, the immunosuppression required to prevent graft rejection predisposes recipients to opportunistic infections, among which cytomegalovirus (CMV) remains a leading cause of morbidity and mortality. To determine the incidence of CMV infection in kidney transplant recipients and identify clinical and laboratory predictors and associated risk factors. A systematic review and meta-analysis, registered in PROSPERO (CRD42024524165), was conducted in accordance with PRISMA guidelines. PubMed, Web of Science, and LILACS databases were searched up to 6 March 2024 for cohort studies reporting CMV incidence post-kidney transplantation. Methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). Publication bias was evaluated using funnel plots, Egger's test, Kendall's tau, and the fail-safe N. Fifteen studies met the inclusion criteria, comprising 3888 patients with a mean age of 45.1 years and a mean follow-up of 7.14 months. The pooled incidence of CMV infection was 42% (95% CI: 30%-54%), with high heterogeneity (I² = 98.75%; p < 0.001). Sensitivity analysis confirmed the robustness of the results, and no significant publication bias was detected. The main risk factors were: advanced age, paediatric age (< 5 years), donor-recipient serodiscordance (D+/R-), post-transplant lymphopenia, and reduced cell-specific immunity defect. CMV infection remains a common and clinically significant complication following kidney transplantation. With a high incidence and strong association with specific laboratory and clinical predictors. Individualised prevention strategies and early virological and immunological monitoring, especially in high-risk groups, are essential to reduce morbidity and mortality and preserve graft function. PROTOCOL REGISTRATION: PROSPERO: CRD42024524165.