title: Clinical impact of neutropenia related with the preemptive therapy of CMV infection in solid organ transplant recipients.
abstract: OBJECTIVE
  The most frequent adverse events associated with valganciclovir treatment are hematological disturbances such as neutropenia. However, the consequences of neutropenia are unknown. We investigated the clinical impact of neutropenia during CMV preemptive therapy and its relationship with the length of antiviral therapy.
  
  
  METHODS
  An observational, prospective cohort of 67 solid organ transplant recipients receiving CMV preemptive therapy was studied.
  
  
  RESULTS
  Severe neutropenia occurred in 21.8% of the patients at a median of three weeks after initiating antiviral therapy. No association was observed between neutropenia and infection risk in these patients. Liver transplant recipients had 6.7 fold increased risk of neutropenia during CMV therapy compared to kidney transplant recipients (p = 0.012). Patients who developed severe neutropenia received antiviral therapy a median of six days longer than patient who did not (p = 0.457).
  
  
  CONCLUSIONS
  Despite the frequency of neutropenia during CMV preemptive therapy, the incidence of infections is not increased. Adjusting the length of preemptive therapy during the episodes of viremia may be recommended, especially in patients with concurrent risk factors for neutropenia such as liver recipients. Further trials are warranted to confirm the safety of this approach.
authors.affiliation: Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Unit of Infectious Disease, Microbiology and Preventive Medicine, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Martín-Gandul
authors.affiliation: Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Unit of Infectious Disease, Microbiology and Preventive Medicine, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Pérez-Romero
authors.affiliation: Unit of Nephrology and Urology, Spain.
authors.forename: Francisco M
authors.initials: FM
authors.lastname: González-Roncero
authors.affiliation: Service of Clinical Pharmacology, Spain.
authors.forename: Soledad
authors.initials: S
authors.lastname: Berdaguer
authors.affiliation: Hepatobiliary and Pancreatic Surgery and Hepatic Transplant Unit, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Gómez
authors.affiliation: Service of Cardiology, Hospitales Universitarios Virgen del Rocío, Sevilla, Spain.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Lage
authors.affiliation: Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Unit of Infectious Disease, Microbiology and Preventive Medicine, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Sánchez
authors.affiliation: Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Unit of Infectious Disease, Microbiology and Preventive Medicine, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Cisneros
authors.affiliation: Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Unit of Infectious Disease, Microbiology and Preventive Medicine, Spain; Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015), Instituto de Salud Carlos III, Madrid, Spain. Electronic address: elisacorderom@gmail.com.
authors.forename: Elisa
authors.initials: E
authors.lastname: Cordero
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000453:epidemiology*; D003586:Cytomegalovirus Infections / Q000188:drug therapy*; D005260:Female; D015774:Ganciclovir / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced* / Q000150:complications; D012307:Risk Factors; D066027:Transplant Recipients; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir
keywords: Cytomegalovirus; Neutropenia; Preemptive therapy; Solid organ transplant; Valganciclovir