title: Primary CMV infections are common in kidney transplant recipients after 6 months valganciclovir prophylaxis.
abstract: Prolonging cytomegalovirus (CMV) prophylaxis in CMV seronegative recipients of a kidney from CMV seropositive donor (D+/R-) may reduce the incidence of late infections. We analyzed late-onset primary CMV infections after 6 months valganciclovir prophylaxis. Data from all CMV D+/R- kidney transplant recipients between January 2004 and December 2008 at our center were analyzed. Patients with a functioning graft at 6 months after transplantation who received 6 months of valganciclovir prophylaxis 900 mg once daily were included (N = 127). CMV was diagnosed with quantitative PCR. Prophylaxis was completed in 119 patients. Prophylaxis was stopped at 3-5 months due to leukopenia or gastrointestinal side effects in eight patients. Late-onset primary CMV infection developed in 47/127 (37%) patients median 244 days after transplantation (range 150-655) and median 67 days after the cessation of prophylaxis (range 1-475). Four infections were asymptomatic. In others, symptoms included fever (N = 28), gastrointestinal symptoms (nausea, vomiting, diarrhea) (N = 24), respiratory tract symptoms (N = 12), and hepatopathy (N = 6). Median peak viral load was 13500 copies/mL (range 400-2,831,000). Recurrent CMV infection developed in 9/47 (19%) patients. No significant risk factors for CMV infection were identified. Symptomatic primary CMV infections were commonly detected also after prolonged valganciclovir prophylaxis.
authors.affiliation: Department of Medicine, Division of Nephrology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. ilkka.helantera@helsinki.fi
authors.forename: I
authors.initials: I
authors.lastname: Helanterä
authors.forename: L
authors.initials: L
authors.lastname: Kyllönen
authors.forename: I
authors.initials: I
authors.lastname: Lautenschlager
authors.forename: K
authors.initials: K
authors.lastname: Salmela
authors.forename: P
authors.initials: P
authors.lastname: Koskinen
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control* / Q000821:virology; D004334:Drug Administration Schedule; D015774:Ganciclovir / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D005767:Gastrointestinal Diseases / Q000821:virology; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D012008:Recurrence; D000077562:Valganciclovir; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir