Racial and Ethnic Disparities in Cytomegalovirus Disease Progression Among Kidney Transplant Recipients: A Single-Center Exploratory Study

Background Cytomegalovirus (CMV) is a major cause of morbidity in kidney transplant recipients. However, little is known about racial and ethnic disparities in CMV outcomes. This study explored the potential differences in CMV disease progression among different racial and ethnic groups. Methods This single-center retrospective cohort study included adult kidney transplant recipients who developed CMV viremia (≥200 copies/mL) between January 2012 and July 2022. The primary outcome was the progression to CMV syndrome or invasive disease. Secondary outcomes included disease severity, 12-month mortality, and graft failure. Patients were categorized as non-Hispanic white or racial/ethnic minorities. Results Of 31 patients with CMV viremia, 28 (90.3%) were racial/ethnic minorities (15 Hispanic, 11 Native American, 2 other), despite minorities representing 52% of the overall transplant population. Progression to CMV syndrome or invasive disease occurred in 13 (41.9%) patients. Among the 13 patients who progressed, 12 (92.3%) were minorities. All 5 patients who developed tissue-invasive disease were minorities. Twelve-month all-cause mortality was 32.3% (n = 10), with 90% of deaths occurring in minorities. Patients who progressed had higher median initial viral loads than those who did not (4,680 vs. 1,565 copies/mL; p = .12). Conclusion Racial and ethnic minorities comprised 90.3% of patients who developed CMV viremia and experienced nearly all disease progression, despite representing half of the transplant population. These preliminary findings warrant validation through larger multicenter studies that incorporate socioeconomic, geographic, and immunogenetic variables to identify modifiable factors contributing to disparities and to guide equitable interventions.