title: Preemptive therapy versus valgancyclovir prophylaxis in cytomegalovirus-positive kidney transplant recipients receiving antithymocyte globulin induction.
abstract: International consensus guidelines on the management of cytomegalovirus (CMV) infections in kidney transplantation recommend the use of universal prophylaxis over preemptive therapy for the highest risk kidney transplant recipients (KTR), namely donor+/recipient - CMV serostatus. However, no universal recommendations have been made for R+ KTR undergoing antithymocyte globulin (ATG) induction. In this retrospective study, we compared 1-year outcomes among 24 R+ KTR who received 3 months of valgancyclovir prophylaxis with 72 R+ KTR who were subjected to a preemptive strategy. All subjects received ATG induction. The incidence of CMV infection was significantly higher among the preemptive subjects versus the prophylaxis group (78% versus 38%, respectively; P = .0003), whereas the incidence of CMV disease was low and did not differ significantly between the cohorts (8% versus 7% respectively, P = .8). Late-onset CMV infections were only observed in the prophylaxis group (25% versus 0%, P = .0001). Finally, the rate of opportunistic infections, acute rejection episodes, and graft/patient survivals at 1 year were also similar between the two groups. In light of this study, preemptive therapy and universal prophylaxis were almost equally effective to prevent CMV infection among R+ KTR receiving ATG induction.
authors.affiliation: Service de Néphrologie-Transplantation, Centre Hospitalier Universitaire, Hôpital Pellegrin, Bordeaux, France. lionel.couzi@chu-bordeaux.fr
authors.forename: L
authors.initials: L
authors.lastname: Couzi
authors.forename: S
authors.initials: S
authors.lastname: Helou
authors.forename: T
authors.initials: T
authors.lastname: Bachelet
authors.forename: S
authors.initials: S
authors.lastname: Martin
authors.forename: K
authors.initials: K
authors.lastname: Moreau
authors.forename: D
authors.initials: D
authors.lastname: Morel
authors.forename: M E
authors.initials: ME
authors.lastname: Lafon
authors.forename: I
authors.initials: I
authors.lastname: Garrigue
authors.forename: P
authors.initials: P
authors.lastname: Merville
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000961:Antilymphocyte Serum / Q000009:adverse effects*; D000998:Antiviral Agents / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000276:immunology / Q000401:mortality / Q000517:prevention & control*; D004334:Drug Administration Schedule; D005260:Female; D005602:France / Q000453:epidemiology; D015774:Ganciclovir / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006084:Graft Rejection / Q000453:epidemiology / Q000276:immunology; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000453:epidemiology / Q000276:immunology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D000077562:Valganciclovir
chemical_list: D000961:Antilymphocyte Serum; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D000077562:Valganciclovir; D015774:Ganciclovir