Long-term renal graft function and survival in patients with high-risk for cytomegalovirus infection receiving preemptive therapy.
BACKGROUND
Preemptive therapy reduces the risk of cytomegalovirus disease in high-risk kidney transplant patients. The advantage of this strategy is that only a fraction of patients receive antiviral drugs for a limited time, which decreases costs and toxicity but requires frequent monitoring and may not prevent complications of asymptomatic cytomegalovirus replication.


METHODS
Long-term graft-function and patient survival of high-risk kidney transplant patients who received preemptive therapy guided by pp65 antigenemia was compared to those whose assay remained negative throughout the first post-transplant year.


RESULTS
Between August 1997 and March 2005, 24 of 272 patients were CMV D+/R-. Thirteen of the 24 (54.2%) developed a positive CMV assay during follow-up; the time between transplant and first positive antigenemia was 66.7 +/- 58.3 days (range 29-251 days). Four patients developed symptoms associated with CMV, one of whom succumbed from complications of CMV neumonitis. Overall, no significant differences were observed in SCr, eGFR, delta SCr, and delta eGFR during a 60-month followup between patients who developed CMV infection or disease and those who remained pp65 antigenemia-negative throughout the first 12 post-transplant months. Additionally, no deaths or graft loss occurred during the long-term follow up of this cohort.


CONCLUSIONS
Our results suggest that in this high risk group of kidney transplant recipients, treating CMV replication using a preemptive strategy during the first posttransplant year is associated with a low rate of CMV complications and probably interferes with the alleged long-term negative indirect effects of CMV on kidney function and survival.
Alberú
Josefina
J
Departamento de Trasplantes, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, DF México.
Morales-Buenrostro
Luis E
LE
Correa-Rotter
Ricardo
R
Muñoz-Trejo
Teresa
T
Zúñiga-Varga
Javier
J
Cuéllar-González
Juan V
JV
Mayorga-Madrigal
Hector
H
Vanegas-Carrero
Ramón
R
Aranda
Francisco
F
Rodríguez-Romo
Roxana
R
Herrera-Garcia
Carlos
C
González-Michaca
Luis
L
Sierra-Madero
Juan G
JG
D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D003587:Cytomegalovirus / Q000276:immunology / Q000502:physiology; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D008297:Male; D010750:Phosphoproteins / Q000097:blood; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011292:Premedication; D011446:Prospective Studies; D012306:Risk; D013997:Time Factors; D014763:Viral Matrix Proteins / Q000097:blood; D014766:Viremia / Q000175:diagnosis / Q000188:drug therapy; D014779:Virus Replication; D055815:Young Adult
D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D010750:Phosphoproteins; D014763:Viral Matrix Proteins; C065418:cytomegalovirus matrix protein 65kDa; D003404:Creatinine