title: A new strategy of delayed long-term prophylaxis could prevent cytomegalovirus disease in (D+/R-) solid organ transplant recipients.
abstract: Long-term prophylaxis against cytomegalovirus (CMV) started immediately after transplantation in (D+/R-) poses a higher risk of late-onset CMV disease. Delayed CMV prophylaxis could allow a transitory exposure of the immune system to CMV, which would let the immune system mount an adequate CMV-specific cytotoxic response in (D+/R-) patients and confer protection against CMV disease. We included all (D+/R-) solid organ transplant recipients (SOT) performed at our institution (January 3/October 6) who received CMV prophylaxis (mainly with oral valganciclovir) during 100 d. In the first period (until December 4), prophylaxis was initiated immediately after transplantation (conventional prophylaxis: CP). Since January 5, it was initiated after 14 d (delayed prophylaxis: DP). Incidence and severity of CMV disease was compared between both groups. A total of 44 SOT recipients were included (CP: 26 and DP: 18). CMV disease was diagnosed in eight patients (18%), seven of 26 (27%) in the CP group, and one of 18 (5.5%) in the DP group (p = 0.07). CMV colitis was reported in five of 26 patients in the CP group (19%), whereas there were no cases of visceral CMV disease in the DP group (p = 0.048). A 14-d delay in the beginning of long-term prophylaxis against CMV in (D+/R-) is safe and could prevent the onset of late-CMV disease.
authors.affiliation: Unit of Infectious Diseases, Hospital Universitario Doce de Octubre, Universidad Complutense, Madrid, Spain. rafasjg@yahoo.es
authors.forename: R
authors.initials: R
authors.lastname: San Juan
authors.forename: M
authors.initials: M
authors.lastname: Yebra
authors.forename: C
authors.initials: C
authors.lastname: Lumbreras
authors.forename: F
authors.initials: F
authors.lastname: López-Medrano
authors.forename: M
authors.initials: M
authors.lastname: Lizasoain
authors.forename: J C
authors.initials: JC
authors.lastname: Meneu
authors.forename: J
authors.initials: J
authors.lastname: Delgado
authors.forename: A
authors.initials: A
authors.lastname: Andrés
authors.forename: J M
authors.initials: JM
authors.lastname: Aguado
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000472:pathogenicity*; D003586:Cytomegalovirus Infections / Q000517:prevention & control* / Q000821:virology; D015774:Ganciclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006084:Graft Rejection / Q000276:immunology*; D006801:Humans; D016377:Organ Transplantation; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D014181:Transplantation Immunology; D016896:Treatment Outcome; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir