Risk Factors And The Predictive Value Of Innate Immune Molecules (MBL) For Cytomegalovirus Infection In Renal Transplantation Recipients

Objective:The study was to analyze the main risk factors and the predictive value of innateimmune molecules MBL (mannose-binding lectin) to predict CMV infection after renaltransplantation.Methods:83renal transplantation patients were selected from January2010to June2011as researchsubjects who all have more than6months following-ups. This study was approved by localethical committee and the informed consent of all participating subjects was obtained.During the followed-up period, copies of CMV deoxyribonucleic acid (DNA) in blood andurine were detected by fluorescence quantitative polymerase chain reaction (FQ-PCR).Patients were diagnosed as CMV infection when CMV DNA was over103copies/ml inblood or concentrated urine.83patients were divided into CMV infection group and nonCMV infection group. The levels of pre-operative serum MBL of renal transplantrecipients were detected by enzyme-linked immune absorbent assay (ELISA) andcompared in two groups. One-way analysis was used in6factors which might affect CMVinfection. Logistic multi-factor regression analysis was then used in significant factors of one-way analysis. And the independent risk factors were selected.Results:During the follow-up period of6months,18recipients (22%) developed CMVinfection(CMV infection group), and65recipients did not delvelop CMV infection (nonCMV infection group). The levels of serum MBL of recipients in CMV infection groupbefore transplantation were significantly lower than those in non CMV infection group(P<0.01). After the therapy of ganciclovir, the copies of CMV decreased to gegative in18recipients with CMV infection. No CMV pneumonia or graft dysfunction occurred. Theresult of one-way analysis showed that the risk factors of CMV infection included CMVserology positive of donors/negative of recipients (D+/R-).before transplantation,MBL<500ng/ml, application of antithymocyte globulin(ATG) and occurrence of rejectionafter transplantation (P=0.018,0.001,0.011,0.005), respectively). The result of Logisticmulti-factor regression analysis showed that the independent risk factors of CMV infectionincluded the level of pre-operative MBL<500ng/ml before renal transplantation (odds ratio5.691,95%confidence interval1.746-18.548, P=0.004) and CMV serology positive ofdonors/negative of recipients (D+/R-)(odds ration7.673,95%confidence interval1.107-53.178, P=0.039).Conclusions:The level of pre-operative MBL (<500ng/ml) and CMV serology positive ofdonors/negative of recipients (D+/R-) before transplantation are the independent riskfactors of CMV infection after renal transplantation. The level of serum MBL if recipientsbefore transplantation can predict the occurrence of CMV infection after renaltransplantation, prephylaxis of virus infection should be applied before the operation. Inpairing between donors and recipients, it should be avoided to transplant kidney from CMVserology positive donors to negative recipients.