title: Cytomegalovirus prevention strategies in seropositive kidney transplant recipients: an insight into current clinical practice.
abstract: There is notable heterogeneity in the implementation of cytomegalovirus (CMV) prevention practices among CMV-seropositive (R+) kidney transplant (KT) recipients. In this prospective observational study, we included 387 CMV R+ KT recipients from 25 Spanish centers. Prevention strategies (antiviral prophylaxis or preemptive therapy) were applied according to institutional protocols at each site. The impact on the 12-month incidence of CMV disease was assessed by Cox regression. Asymptomatic CMV infection, acute rejection, graft function, non-CMV infection, graft loss, and all-cause mortality were also analyzed (secondary outcomes). Models were adjusted for a propensity score (PS) analysis for receiving antiviral prophylaxis. Overall, 190 patients (49.1%) received preemptive therapy, 185 (47.8%) antiviral prophylaxis, and 12 (3.1%) no specific intervention. Twelve-month cumulative incidences of CMV disease and asymptomatic infection were 3.6% and 39.3%, respectively. Patients on prophylaxis had lower incidence of CMV disease [PS-adjusted HR (aHR): 0.10; 95% confidence interval (CI): 0.01-0.79] and asymptomatic infection (aHR: 0.46; 95% CI: 0.29-0.72) than those managed preemptively, with no significant differences according to the duration of prophylaxis. All cases of CMV disease in the prophylaxis group occurred after prophylaxis discontinuation. There were no differences in any of the secondary outcomes. In conclusion, antiviral prophylaxis was associated with a lower occurrence of CMV disease in CMV R+ KT recipients, although such benefit should be balanced with the risk of late-onset disease.
authors: Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Madrid, Spain.
authors: Mario
authors: M
authors: Fernández-Ruiz
authors: Department of Nephrology, Hospital Universitario "Marqués de Valdecilla", Instituto de Formación e Investigación "Marqués de Valdecilla" (IFIMAV), Santander, Spain.
authors: Manuel
authors: M
authors: Arias
authors: Department of Nephrology, Hospital Clinic, Institut d'Investigacions Biomèdiques "August Pi i Sunyer" (IDIBAPS), Barcelona, Spain.
authors: Josep M
authors: JM
authors: Campistol
authors: Department of Microbiology, Hospital Clínico Universitario, Instituto de Investigación Sanitaria INCLIVA, University of Valencia, Valencia, Spain.
authors: David
authors: D
authors: Navarro
authors: Department of Nephrology, Hospital Central de Asturias, Oviedo, Spain.
authors: Ernesto
authors: E
authors: Gómez-Huertas
authors: Department of Nephrology, Hospital Universitario Son Espases, Palma de Mallorca, Spain.
authors: Gonzalo
authors: G
authors: Gómez-Márquez
authors: Department of Nephrology, Fundació Puigvert, Barcelona, Spain.
authors: Juan Manuel
authors: JM
authors: Díaz
authors: Department of Nephrology, Hospital Universitario "Carlos Haya", Málaga, Spain.
authors: Domingo
authors: D
authors: Hernández
authors: Department of Nephrology, Hospital Universitario "Virgen del Rocío", Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain.
authors: Gabriel
authors: G
authors: Bernal-Blanco
authors: Department of Nephrology, Hospital Clinic, Institut d'Investigacions Biomèdiques "August Pi i Sunyer" (IDIBAPS), Barcelona, Spain.
authors: Frederic
authors: F
authors: Cofan
authors: Department of Nephrology, Hospital Universitario "Virgen de la Arrixaca", El Palmar, Murcia, Spain.
authors: Luisa
authors: L
authors: Jimeno
authors: Unit of Nephrology, Hospital General de Alicante, Alicante, Spain.
authors: Antonio
authors: A
authors: Franco-Esteve
authors: Department of Nephrology, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Madrid, Spain.
authors: Esther
authors: E
authors: González
authors: Department of Nephrology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors: Francesc J
authors: FJ
authors: Moreso
authors: Department of Nephrology, Hospital Universitario "Marqués de Valdecilla", Instituto de Formación e Investigación "Marqués de Valdecilla" (IFIMAV), Santander, Spain.
authors: Carlos
authors: C
authors: Gómez-Alamillo
authors: Department of Nephrology, Hospital Clínico Universitario, Valladolid, Spain.
authors: Alicia
authors: A
authors: Mendiluce
authors: Department of Nephrology, Hospital Universitario "Infanta Cristina", Badajoz, Spain.
authors: Enrique
authors: E
authors: Luna-Huerta
authors: Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Madrid, Spain.
authors: José María
authors: JM
authors: Aguado
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000150:complications / Q000517:prevention & control*; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D005919:Glomerular Filtration Rate; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000150:complications* / Q000601:surgery*; D012307:Risk Factors; D013030:Spain; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D000077562:Valganciclovir; D015774:Ganciclovir
keywords: antiviral prophylaxis; cytomegalovirus; kidney transplantation; multicenter study; preemptive therapy; seropositive recipient