title: Impact of antiviral preventive strategies on the incidence and outcomes of cytomegalovirus disease in solid organ transplant recipients.
abstract: We assessed the impact of antiviral prophylaxis and preemptive therapy on the incidence and outcomes of cytomegalovirus (CMV) disease in a nationwide prospective cohort of solid organ transplant recipients. Risk factors associated with CMV disease and graft failure-free survival were analyzed using Cox regression models. One thousand two hundred thirty-nine patients transplanted from May 2008 until March 2011 were included; 466 (38%) patients received CMV prophylaxis and 522 (42%) patients were managed preemptively. Overall incidence of CMV disease was 6.05% and was linked to CMV serostatus (D+/R- vs. R+, hazard ratio [HR] 5.36 [95% CI 3.14-9.14], p < 0.001). No difference in the incidence of CMV disease was observed in patients receiving antiviral prophylaxis as compared to the preemptive approach (HR 1.16 [95% CI 0.63-2.17], p = 0.63). CMV disease was not associated with a lower graft failure-free survival (HR 1.27 [95% CI 0.64-2.53], p = 0.50). Nevertheless, patients followed by the preemptive approach had an inferior graft failure-free survival after a median of 1.05 years of follow-up (HR 1.63 [95% CI 1.01-2.64], p = 0.044). The incidence of CMV disease in this cohort was low and not influenced by the preventive strategy used. However, patients on CMV prophylaxis were more likely to be free from graft failure.
authors.affiliation: Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland; Infectious Diseases Service, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
authors.forename: O
authors.initials: O
authors.lastname: Manuel
authors.forename: G
authors.initials: G
authors.lastname: Kralidis
authors.forename: N J
authors.initials: NJ
authors.lastname: Mueller
authors.forename: H H
authors.initials: HH
authors.lastname: Hirsch
authors.forename: C
authors.initials: C
authors.lastname: Garzoni
authors.forename: C
authors.initials: C
authors.lastname: van Delden
authors.forename: C
authors.initials: C
authors.lastname: Berger
authors.forename: K
authors.initials: K
authors.lastname: Boggian
authors.forename: A
authors.initials: A
authors.lastname: Cusini
authors.forename: M T
authors.initials: MT
authors.lastname: Koller
authors.forename: M
authors.initials: M
authors.lastname: Weisser
authors.forename: M
authors.initials: M
authors.lastname: Pascual
authors.forename: P R
authors.initials: PR
authors.lastname: Meylan
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D011446:Prospective Studies; D012307:Risk Factors; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir
keywords: Antiviral prophylaxis; graft loss; indirect effects; preemptive therapy; valganciclovir