Choice of induction regimens on the risk of cytomegalovirus infection in donor-positive and recipient-negative kidney transplant recipients.
BACKGROUND
Late occurrence of cytomegalovirus (CMV) infection remains a concern in CMV-seronegative kidney and/or pancreas transplant recipients of CMV-seropositive organs (donor positive/recipient negative, D+/R-) despite the use of prophylaxis. We investigated the impact of various antibody induction regimens on CMV infection in this group of patients.


METHODS
A total of 254 consecutive D+/R- kidney and/or pancreas transplant patients were studied. The induction agents rabbit anti-thymocyte globulin (rATG) or basiliximab were used according to the center practice. All patients received prophylaxis with valganciclovir (VGCV) for either 3 or 6 months. The occurrence of CMV infection was confirmed by positive DNA viremia. Multivariate Cox regression analyses were performed to determine risk factors for CMV infection.


RESULTS
The cumulative incidence of CMV infection was 58, 112, and 59 cases per 1000 patient-years for patients who received no antibody induction, induction with rATG, or basiliximab induction, respectively (P=0.02). The use of rATG but not basiliximab was associated with an increased risk for CMV infection (adjusted hazard ratio [AHR] 2.13, 95% confidence interval [CI] 1.24-3.54, P=0.006). Acute rejection and its treatment with rATG were not associated with an increased risk for CMV infection when an additional course of VGCV was given following the treatment. Longer duration of prophylaxis was associated with a reduced risk for CMV infection (AHR 0.54, 95% CI 0.33-0.87, P=0.011).


CONCLUSIONS
Induction with rATG is associated with increased risk of CMV infection. Longer duration of prophylaxis is beneficial.
Luan
F L
FL
Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan, USA. fluan@med.umich.edu
Samaniego
M
M
Kommareddi
M
M
Park
J M
JM
Ojo
A O
AO
D000328:Adult; D000818:Animals; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000961:Antilymphocyte Serum / Q000235:genetics / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use; D000077552:Basiliximab; D003587:Cytomegalovirus / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects; D011817:Rabbits; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use*; D012307:Risk Factors; D014019:Tissue Donors; D016896:Treatment Outcome; D000077562:Valganciclovir
D000911:Antibodies, Monoclonal; D000961:Antilymphocyte Serum; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab; D000077562:Valganciclovir; D015774:Ganciclovir