title: Prevention strategies for cytomegalovirus disease and long-term outcomes in the high-risk transplant patient (D+/R-): experience from the RESITRA-REIPI cohort.
abstract: BACKGROUND
  Cytomegalovirus (CMV)-negative recipients of a graft from a CMV-positive donor (D+/R-) are at high risk of CMV disease. Current preventive strategies include universal prophylaxis (UP) and preemptive therapy (PT). However, the best strategy to prevent CMV disease and achieve better long-term outcomes remains a matter of debate.
  
  
  METHODS
  We analyzed the incidence of CMV disease and long-term outcomes including graft dysfunction and patient mortality at 5 years after transplantation with both preventive strategies. High-risk (D+/R-) kidney and liver transplant recipients from the RESITRA cohort were included.
  
  
  RESULTS
  Of 2410 kidney or liver transplant patients, 195 (8.3%) were D+/R-. The final cohort included 58 liver and 102 kidney recipients. UP was given in 92 patients and 68 received PT; 10.9% and 36.8% developed CMV disease, respectively (P < 0.01). The independent risk factors for CMV disease were PT strategy (hazard ratio [HR], 3.30; 95% confidence interval [CI], 1.6-6.9), kidney transplantation (HR, 3.8; 95% CI, 1.4-9.9), and cyclosporine immunosuppression (HR, 2.4; 95% CI, 1.2-4.7). PT strategy was also a risk factor for CMV disease in both liver transplantation (HR, 11.0; 95% CI, 1.2-98.7) and kidney transplantation (HR, 2.7; 95% CI, 1.3-6.0), independently. The development of CMV replication during the first 2 years after transplantation was a risk factor for graft dysfunction at 5 years after transplantation (odds ratio, 3.4; 95% CI, 1.3-9.0). Nevertheless, no significant differences were seen in either graft dysfunction or mortality between the 2 strategies.
  
  
  CONCLUSIONS
  The study supports the benefit of the UP strategy to prevent CMV disease in D+/R- liver or kidney transplant patients. The development of CMV replication during the first 2 years after transplantation was associated with graft dysfunction at 5 years after transplantation.
authors.affiliation: Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Y
authors.initials: Y
authors.lastname: Meije
authors.forename: J
authors.initials: J
authors.lastname: Fortún
authors.forename: Ó
authors.initials: Ó
authors.lastname: Len
authors.forename: J M
authors.initials: JM
authors.lastname: Aguado
authors.forename: A
authors.initials: A
authors.lastname: Moreno
authors.forename: J M
authors.initials: JM
authors.lastname: Cisneros
authors.forename: M
authors.initials: M
authors.lastname: Gurguí
authors.forename: J
authors.initials: J
authors.lastname: Carratalà
authors.forename: P
authors.initials: P
authors.lastname: Muñoz
authors.forename: M
authors.initials: M
authors.lastname: Montejo
authors.forename: M
authors.initials: M
authors.lastname: Blanes
authors.forename: G
authors.initials: G
authors.lastname: Bou
authors.forename: J L
authors.initials: JL
authors.lastname: Pérez
authors.forename: J
authors.initials: J
authors.lastname: Torre-Cisneros
authors.forename: A
authors.initials: A
authors.lastname: Ramos
authors.forename: A
authors.initials: A
authors.lastname: Pahissa
authors.forename: J
authors.initials: J
authors.lastname: Gavaldà
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000494:pharmacology; D015331:Cohort Studies; D003587:Cytomegalovirus / Q000502:physiology; D003586:Cytomegalovirus Infections / Q000209:etiology* / Q000517:prevention & control*; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives* / Q000494:pharmacology*; D006801:Humans; D007166:Immunosuppressive Agents; D016030:Kidney Transplantation / Q000009:adverse effects*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D000077562:Valganciclovir; D014779:Virus Replication; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D000077562:Valganciclovir; D015774:Ganciclovir
keywords: D+/R−; cytomegalovirus; graft dysfunction; preemptive therapy; transplantation; universal prophylaxis