Cytomegalovirus disease after prophylaxis with oral ganciclovir in renal transplantation: the importance of HLA-DR matching.
This study assessed the incidence of cytomegalovirus (CMV) disease and associated outcomes after oral ganciclovir prophylaxis in renal transplantation. A retrospective analysis was performed of all adult renal transplant recipients at a single transplant center transplanted between August 16, 1996, and December 31, 2000. CMV disease prophylaxis included ganciclovir 1000 mg orally thrice daily prescribed for 90 d in D-/R+ cases and 180 d in D+/R- and D+/R+ cases. Forty (9.1%) of 470 patients studied were diagnosed with CMV disease, which varied significantly by CMV serostatus and number of HLA-DR matches. The highest incidence of disease, 26.2%, was in D+/R- patients with zero HLA-DR matches. Five-year graft survival was 56.8% with CMV disease compared with 79.1% without (P < 0.001). Five-year graft survival with CMV disease was 75.9% with one or two HLA-DR matches versus 16.2% with zero HLA-DR matches (P < 0.001). CMV remains an important factor in long-term graft survival after oral ganciclovir prophylaxis. However, we have observed that the adverse impact of CMV disease on graft survival is apparent only in patients with zero HLA-DR matches. These results call for the development of new CMV disease prophylaxis and treatment strategies in patients with zero HLA-DR matches. In addition, organ allocation policies discouraging combining CMV-seropositive donors and zero HLA-DR matches may be worth consideration.
Schnitzler
Mark A
MA
Pharmaco-Economic Transplant Research, The Health Administration Program, Washington University School of Medicine, St. Louis, Missouri 63110, USA. schnitz@wueconc.wustl.edu
Lowell
Jeffrey A
JA
Hmiel
S Paul
SP
Hardinger
Karen L
KL
Liapis
Helen
H
Ceriotti
Connie S
CS
Brennan
Daniel C
DC
D000284:Administration, Oral; D000998:Antiviral Agents / Q000008:administration & dosage*; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage*; D006085:Graft Survival / Q000276:immunology; D006684:HLA-DR Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
D000998:Antiviral Agents; D006684:HLA-DR Antigens; D015774:Ganciclovir