Impact of Prophylaxis vs Pre-emptive Approach for Cytomegalovirus Infection in Kidney Transplant Recipients

• Published in: Transplantation proceedings Vol. 49; no. 3; pp. 537 - 540
• Main Authors: Kır, O, Zeytinoğlu, A, Arda, B, Yılmaz, M, Aşçı, G, Töz, H
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2017
• Subjects: Acyclovir - therapeutic use; Adolescent; Adult; Aged; Antiviral Agents - therapeutic use; Cytomegalovirus; Cytomegalovirus Infections - mortality; Cytomegalovirus Infections - prevention & control; Female; Ganciclovir - analogs & derivatives; Ganciclovir - therapeutic use; Graft Survival; Humans; Kidney Diseases - mortality; Kidney Diseases - surgery; Kidney Diseases - virology; Kidney Transplantation - adverse effects; Kidney Transplantation - methods; Kidney Transplantation - mortality; Male; Middle Aged; Premedication - mortality; Risk Factors; Surgery; Transplant Recipients; Young Adult
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2017.01.027

Abstract Cytomegalovirus (CMV) is the most common viral infection during the post-transplant period, and it is one of the major causes of morbidity and mortality in kidney transplantation. In this study, the incidence and impact of pre-emptive and prophylactic approaches and long-term effects on graft and patient survival of CMV infection were investigated. Among 493 adult kidney transplant recipients, pretransplant CMV IgG-negative patients and patients with a follow-up shorter than a month were excluded. The patients were divided into 2 groups: pre-emptive group (n = 187, regular screening and acyclovir 400 mg twice daily for 6 months), and prophylaxis group (n = 275, valganciclovir 450 mg/d for 3 months). The pre-emptive group was screened for CMV with either pp65 antigenemia or CMV DNA. There were 462 patients, and mean follow-up was 37.7 months. There were more CMV infections in the pre-emptive group than in the prophylaxis group (n = 56, 30.1% vs n = 12, 4.4%, respectively; P  < .001). Late CMV infections were significantly more frequent in the prophylaxis group (10 of 12, 83.3%) than in the pre-emptive group (8 of 56, 14.3%, P  < .001). In multivariate analysis, valganciclovir prophylaxis was associated with a lower CMV infection (relative risk [RR]: 0.18, 95% confidence interval [CI] 0.08 to 0.39, P  < .001). Delayed graft function was the only independent risk factor for graft loss during the follow-up on multivariate Cox regression analysis (RR: 2.66, 95% GA 1.17 to 6.04, P  = .02). Valganciclovir prophylaxis was more protective against CMV infection than the pre-emptive approach. Neither prophylaxis/pre-emptive approaches nor CMV infection had negative effect on graft and patient survival.