title: Six-month low-dose valganciclovir prophylaxis in cytomegalovirus D+/R- kidney transplant patients receiving thymoglobulin induction.
abstract: BACKGROUND
  The use of T-cell-depleting antibody, such as thymoglobulin, is a risk factor for cytomegalovirus (CMV) infection. We studied the effectiveness of 6 months of low-dose valganciclovir prophylaxis in CMV-naive kidney transplant recipients of CMV-positive donor kidney (D+/R-) receiving thymoglobulin induction.
  
  
  METHODS
  We included all D+/R- kidney transplant patients between October 2005 and December 2010 who received valganciclovir 450 mg daily for 6 months as per center protocol. CMV infection was confirmed by positive viremia. Kaplan-Meier and multivariate Cox proportional regression analyses were employed to compare the risk of CMV infection between patients with and without the use of thymoglobulin induction.
  
  
  RESULTS
  Out of 170 D+/R- kidney transplant patients, 42 cases of CMV infection (24.6%) were diagnosed after a median follow-up of 3.2 years: six patients from the noninduction (9.4%) and 36 from the induction cohort (34.0%). The induction with thymoglobulin was associated with four times greater risk of developing CMV infection (adjusted hazard ratio: AHR 4.15, 95% 1.75, 9.86, P = .001). The use of thymoglobulin was associated with leukopenia but not neutropenia.
  
  
  CONCLUSIONS
  Additional measures are needed to reduce the elevated incidence of CMV infection in D+/R- kidney transplant patients receiving induction with thymoglobulin.
authors.affiliation: Department of Internal Medicine, Division of Nephrology, University of Michigan, Ann Arbor, Michigan48109-5364, USA.
authors.forename: F L
authors.initials: FL
authors.lastname: Luan
mesh_terms: D000328:Adult; D000961:Antilymphocyte Serum / Q000276:immunology*; D000998:Antiviral Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000150:complications / Q000188:drug therapy* / Q000517:prevention & control; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D007970:Leukopenia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000209:etiology; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome; D000077562:Valganciclovir
chemical_list: D000961:Antilymphocyte Serum; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; C512542:thymoglobulin; D000077562:Valganciclovir; D015774:Ganciclovir