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See 1 citation in Transpl Int 2015:

Transpl Int. 2015 Sep;28(9):1042-54. doi: 10.1111/tri.12586. Epub 2015 Apr 23.

Cytomegalovirus prevention strategies in seropositive kidney transplant recipients: an insight into current clinical practice.

Author information

1
Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Madrid, Spain.
2
Department of Nephrology, Hospital Universitario "Marqués de Valdecilla", Instituto de Formación e Investigación "Marqués de Valdecilla" (IFIMAV), Santander, Spain.
3
Department of Nephrology, Hospital Clinic, Institut d'Investigacions Biomèdiques "August Pi i Sunyer" (IDIBAPS), Barcelona, Spain.
4
Department of Microbiology, Hospital Clínico Universitario, Instituto de Investigación Sanitaria INCLIVA, University of Valencia, Valencia, Spain.
5
Department of Nephrology, Hospital Central de Asturias, Oviedo, Spain.
6
Department of Nephrology, Hospital Universitario Son Espases, Palma de Mallorca, Spain.
7
Department of Nephrology, Fundació Puigvert, Barcelona, Spain.
8
Department of Nephrology, Hospital Universitario "Carlos Haya", Málaga, Spain.
9
Department of Nephrology, Hospital Universitario "Virgen del Rocío", Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain.
10
Department of Nephrology, Hospital Universitario "Virgen de la Arrixaca", El Palmar, Murcia, Spain.
11
Unit of Nephrology, Hospital General de Alicante, Alicante, Spain.
12
Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Madrid, Spain.
13
Department of Nephrology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
14
Department of Nephrology, Hospital Clínico Universitario, Valladolid, Spain.
15
Department of Nephrology, Hospital Universitario "Infanta Cristina", Badajoz, Spain.

Abstract

There is notable heterogeneity in the implementation of cytomegalovirus (CMV) prevention practices among CMV-seropositive (R+) kidney transplant (KT) recipients. In this prospective observational study, we included 387 CMV R+ KT recipients from 25 Spanish centers. Prevention strategies (antiviral prophylaxis or preemptive therapy) were applied according to institutional protocols at each site. The impact on the 12-month incidence of CMV disease was assessed by Cox regression. Asymptomatic CMV infection, acute rejection, graft function, non-CMV infection, graft loss, and all-cause mortality were also analyzed (secondary outcomes). Models were adjusted for a propensity score (PS) analysis for receiving antiviral prophylaxis. Overall, 190 patients (49.1%) received preemptive therapy, 185 (47.8%) antiviral prophylaxis, and 12 (3.1%) no specific intervention. Twelve-month cumulative incidences of CMV disease and asymptomatic infection were 3.6% and 39.3%, respectively. Patients on prophylaxis had lower incidence of CMV disease [PS-adjusted HR (aHR): 0.10; 95% confidence interval (CI): 0.01-0.79] and asymptomatic infection (aHR: 0.46; 95% CI: 0.29-0.72) than those managed preemptively, with no significant differences according to the duration of prophylaxis. All cases of CMV disease in the prophylaxis group occurred after prophylaxis discontinuation. There were no differences in any of the secondary outcomes. In conclusion, antiviral prophylaxis was associated with a lower occurrence of CMV disease in CMV R+ KT recipients, although such benefit should be balanced with the risk of late-onset disease.

KEYWORDS:

antiviral prophylaxis; cytomegalovirus; kidney transplantation; multicenter study; preemptive therapy; seropositive recipient

PMID:
25864986
DOI:
10.1111/tri.12586
[Indexed for MEDLINE]
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