Background: The
aquaporin 5 (AQP5) -1364A/C promoter single nucleotide polymorphism affects key mechanisms of
inflammation and immune cell migration. Thus, it could be involved in the pathogenesis of
cytomegalovirus infection. Accordingly, we tested the hypothesis that the AQP5 promoter -1364A/C polymorphism is associated with the risk of
cytomegalovirus infection in
kidney transplantation recipients. Methods: We included 259 adult patients who received a kidney transplant from 2007 and 2014 in this observational study. Patients were genotyped for the AQP5 promoter -1364A/C single nucleotide polymorphism and followed up for 12 months after
transplantation. Kaplan-Meier plots and multivariable proportional hazard analyses were used to evaluate the relationship between genotypes and the incidence of
cytomegalovirus infection. Results: The incidences of
cytomegalovirus infection within 12 months after
kidney transplantation were 22.9% for the AA genotypes (43/188) and 42.3% for the AC/CC genotypes (30/71; p = 0.002). Furthermore, multivariable COX regression revealed the C-allele of the AQP5 -1364A/C polymorphism to be a strong and independent risk factor for
cytomegalovirus infection. In this analysis, AC/CC subjects demonstrated a more than 2-fold increased risk for
cytomegalovirus infection within the first year after
kidney transplantation (hazard ratio: 2.28; 95% CI: 1.40-3.73; p = 0.001) compared to that in individuals with homozygous AA genotypes. Conclusions: With respect to opportunistic
cytomegalovirus infections (attributable to immunosuppression after
kidney transplantation), the C-allele of the AQP5 -1364A/C promoter polymorphism is independently associated with an increased 12-months
infection risk. These findings emphasize the importance of genetic variations as additional risk factors of
cytomegalovirus infection after solid
organ transplantations and might also facilitate the discovery of novel therapeutic targets.