title: Cytomegalovirus infection post-pancreas-kidney transplantation--results of antiviral prophylaxis in high-risk patients.
abstract: BACKGROUND
  Cytomegalovirus (CMV) is a major pathogen affecting solid organ transplant (SOT) recipients. Prophylactic strategies have decreased the rate of CMV infection/disease among SOT. However, data on the effect of current prophylactic strategies for simultaneous pancreas-kidney (SPK) or pancreas after kidney (PAK) transplant remain limited. We report our experience of CMV prophylaxis in SPK/PAK recipients.
  
  
  METHODS
  A total of 130 post-SPK/PAK patients were analyzed retrospectively for the rate of CMV and the risk factors associated with the acquisition of CMV. All patients received antiviral prophylaxis. The follow-up period was one yr post-transplant or until death.
  
  
  RESULTS
  The rate of CMV post-SPK/PAK transplant was 24%, 44%, and 8.2% among the whole cohort, the D+/R- and the R+ groups, respectively. Median time of prophylaxis was 49 (0-254) d. In the whole cohort, risk factors for CMV infection/diseases were D+/R- CMV status (odds ratio [OR] = 16.075), preceding non-CMV (infection caused by bacteria or fungi and other viruses) infection (OR = 6.362) and the duration of prophylaxis (OR = 0.984). Among the CMV D+/R- group, non-CMV infection was the only risk factor for CMV disease (OR = 10.7).
  
  
  CONCLUSIONS
  Forty-four per cent (25/57) of the D+/R- recipients developed CMV infection/disease despite CMV prophylaxis. Current CMV prophylaxis failed to prevent CMV infection/disease in this group of patients.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Samira M
authors.initials: SM
authors.lastname: Fallatah
authors.forename: Max A
authors.initials: MA
authors.lastname: Marquez
authors.forename: Fateh
authors.initials: F
authors.lastname: Bazerbachi
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Schiff
authors.forename: Mark S
authors.initials: MS
authors.lastname: Cattral
authors.forename: Ian D
authors.initials: ID
authors.lastname: McGilvray
authors.forename: Andrea
authors.initials: A
authors.lastname: Norgate
authors.forename: Markus
authors.initials: M
authors.lastname: Selzner
authors.forename: Coleman
authors.initials: C
authors.lastname: Rotstein
authors.forename: Shahid
authors.initials: S
authors.lastname: Husain
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D002170:Canada / Q000453:epidemiology; D003587:Cytomegalovirus / Q000472:pathogenicity*; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000998:Antiviral Agents
keywords: cytomegalovirus; cytomegalovirus prophylaxis; mismatch; pancreas after kidney; simultaneous pancreas- kidney; simultaneous pancreas- kidney transplantation