Preemptive therapy is not adequate for prevention of cytomegalovirus disease in pancreas-kidney transplant recipients.
BACKGROUND
Cytomegalovirus (CMV) remains the most common viral infection after pancreas-kidney transplantation (PKT). Comparative studies about CMV prophylaxis in PKT have not been developed.


METHODS
We analyzed CMV disease in a cohort of 84 PKT recipients. All received intravenous ganciclovir during treatment with anti-thymocyte globulin and later one of the following options for pre-transplant CMV-seropositive recipients: (a) no prophylaxis (n=10 patients), (b) preemptive therapy (PT) (n=13), or (c) continuous prophylaxis (CP) for 12 weeks (n=29). Pre-transplant CMV-seronegative recipients received CP (n=21).


RESULTS
Eleven patients were excluded because of organ explantation in the first 15 days. Incidence of CMV disease in seropositive recipients was 30% under no prophylaxis, 23% under PT, and 6.9% under CP. Incidence of CMV disease under CP was 33.3% in seronegative recipients. Six of 9 episodes of CMV disease under CP occurred after finishing prophylaxis. Under CP, the incidence of CMV disease was significantly higher in seronegative than in seropositive recipients (P<0.05).


CONCLUSIONS
According to the results of our study, for CMV-seropositive PKT recipients, CP is a better strategy than PT. For CMV-seronegative recipients, 3 months of CP is an inadequate strategy.
López-Medrano
F
F
Infectious Diseases Unit, University Hospital 12 de Octubre, Madrid, Spain. flmedrano@yahoo.es
Rueda
B
B
Lizasoain
M
M
Juan
R San
RS
Folgueira
D
D
Andrés
A
A
Morales
J M
JM
Jiménez
C
C
Meneu
J C
JC
Aguado
J M
JM
D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D018890:Chemoprevention; D015331:Cohort Studies; D003587:Cytomegalovirus / Q000187:drug effects*; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects*; D016896:Treatment Outcome
D000998:Antiviral Agents; D015774:Ganciclovir