Death and Graft Loss in Simultaneous Pancreas-Kidney Recipients by Donor-Recipient Cytomegalovirus Serostatus in the United States
Bibliographic record
Abstract
Cytomegalovirus (CMV) serologic discordance is a known risk factor for adverse outcomes after solid-organ transplantation. This study evaluated outcomes of simultaneous pancreas-kidney (SPK) recipients based on donor and recipient CMV serostatus. Using the Scientific Registry of Transplant Recipients, we identified adult SPK recipients between 2014 and 2024 and categorized them as donor/recipient negative (D-/R-), recipient positive (R+), or donor positive/recipient negative (D+/R-). Patients with missing data, nonstandard immunosuppression, or positive crossmatch were excluded. Among 4,744 recipients (831 D-/R-, 2,671 R+, 1,242 D+/R-), the D+/R- group had the highest 1-year rates of graft rejection (16.6%, p = 0.02) and hospitalization (67.2%, p = 0.005), whereas the D-/R- group had the lowest (11.8% and 60.0%, respectively). In multivariable models, D+/R- recipients had higher risks of death (HR 1.28; 95% CI, 1 .01-1.62; p = 0.045), pancreas graft-loss (HR 1.25; 95% CI, 1.06-1.48; p = 0.009), and death-censored kidney graft-loss (HR 1.31; 95% CI, 1.01-1.69; p = 0.04) compared with R+. Conversely, D-/R- recipients had a lower risk of kidney graft-loss (HR 0.66; 95% CI, 0.46-0.96; p = 0.03). CMV D+/R- serostatus is independently associated with increased mortality and graft-loss after SPK transplantation. Matching CMV-seronegative donors with seronegative recipients may improve outcomes, warranting further study of the feasibility and broader impact of CMV serostatus-based-matching.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".