Changes in Hospitalization in Transplant Recipients with CMV Infection

New Orleans—With increasing use of more aggressive immunosuppressive therapies, cytomegalovirus (CMV) infection has become a frequent complication of kidney transplantation. It is unclear how the burden of inpatient hospitalization related to CMV has changed over time in the United States.

Neetika Garg, MD, and colleagues utilized the National Inpatient Sample 2004-2014 to identify hospitalizations with primary or secondary diagnosis of CMV disease (International Classification of Diseases-Ninth Revision code 078.5) in the setting of known history of kidney transplantation. National estimates were generated using survey analysis techniques. Data on the prevalent kidney transplantation population were derived from the Organ Procurement and Transplantation Network/Survival Following Transplant database.

The researchers reported results of the analysis during a poster session at Kidney Week 2017. The poster was titled Hospitalization Trends for CMV Disease in Kidney Transplant Recipients in the United States, 2004-2014.

The study included 2126 hospitalizations over the 11 years of the study period, representing 10,215 hospitalizations for CMV nationally. Mean age of participants was 52 years, and 44.3% were women. Over the 11-year study period, the rates of hospitalization were stable (6.3 to 5.3 per thousand prevalent recipient population; P for trend=0.75). There was a trend toward increasing hospital mortality (1.8% to 2.9%; P for trend=.07).

There were significant increases in rates of acute kidney injury (9.5% to 32.7%; P<.001), length of stay (7.7 days to 8.5 days; P=.01), and inflation-adjusted costs ($16,323 to $29,723; P<.001). There was also an increase in comorbidity burden, measured by mean Charlson Comorbidity Index during the study period (0.80 to 2.01; P<.001).

“Our study findings may reflect a shift toward outpatient management of CMV diseases with hospitalization only for the sickest patients in the United States. Patient outcomes were worse and resource utilization (duration and costs of hospitalization) were higher for those admitted in more recent years,” the researchers said.

Source: Garg N, Kumar N, Parajuli S, et al. Hospitalization trends for CMV disease in kidney transplant recipients in the United States, 2005-2014. Abstract of a poster presented at the American Society of Nephrology 2017 Kidney Week, November 4, 2017, New Orleans, Louisiana.