Strategies for prevention of cytomegalovirus infection in renal transplant patients.
OBJECTIVE
Cytomegalovirus (CMV) constitutes the principal viral infection in renal transplant patients. The indirect consequences of CMV infection increase the risks for acute and chronic rejection, secondary infections, lymphoproliferative disorders, atherosclerosis, and cardiovascular deaths. The direct effects depend on the affected organ. There have been strategies to prevent CMV disease: prophylaxis and preemptive strategy. The aim of this study was to compare the incidences of disease and infection due to CMV among our patients.


METHODS
We performed a retrospective analysis of all our renal transplant patients between January 2000 and January 2008.


RESULTS
Four groups were identified among 94 patients: without any preventive strategy; brief prophylaxis; formal prophylaxis; and preemptive treatment. There were no significant differences among the groups in the incidences of CMV disease, acute renal rejection, or survival. The greatest number of infections was registered in the group with brief prophylaxis (P = .006); 50% of the registered infections occurred before 150 days posttransplantation.


CONCLUSIONS
We concluded that the preemptive strategy is appropriate for the low-risk patient, while prevention with antiviral drugs should be reserved for intermediate- and high-risk patients. A brief treatment for prevention is an alternative to prevent CMV disease, but it needs to be followed with serial, long-term evaluation of antigenemia for >150 days posttransplantation.
Valenzuela
M
M
Department of Nephrology, Pontificia Universidad Católica de Chile, Santiago, Chile. mavalen2@uc.cl
Ortiz
A M
AM
Troncoso
P
P
Vilches
S
S
D000956:Antigens, Viral / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D004334:Drug Administration Schedule; D004582:Electronics, Medical; D006084:Graft Rejection / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate; D017741:Survivors
D000956:Antigens, Viral; D000998:Antiviral Agents