title: Cytomegalovirus post kidney transplantation: prophylaxis versus pre-emptive therapy?
abstract: Cytomegalovirus is the most important pathogen causing opportunistic infections in kidney allograft recipients. The occurrence of CMV disease is associated with higher morbidity, higher incidence of other opportunistic infections, allograft loss and death. Therefore, an efficient strategy to prevent CMV disease after kidney transplantation is required. Two options are currently available: pre-emptive therapy based on regular CMV PCR monitoring and generalized antiviral prophylaxis during a defined period. In this review, we describe those two approaches, highlight the distinct advantages and risks of each strategy and summarize the four randomized controlled trials performed in this field so far. Taken this evidence together, pre-emptive therapy and anti-CMV prophylaxis are both equally potent in preventing CMV-associated complications; however, the pre-emptive approach may have distinct advantages in allowing for development of long-term anti-CMV immunity. We propose a risk-adapted use of these approaches based on serostatus, immunosuppressive therapy and availability of resources at a particular transplant centre.
authors.affiliation: Department of Internal Medicine, Cantonal Hospital Graubuenden, Chur, Switzerland.|Division of Nephrology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fehr
authors.affiliation: Division of Nephrology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Pietro E
authors.initials: PE
authors.lastname: Cippà
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Nicolas J
authors.initials: NJ
authors.lastname: Mueller
mesh_terms: D000998:Antiviral Agents / Q000494:pharmacology; D003587:Cytomegalovirus / Q000276:immunology / Q000472:pathogenicity; D003586:Cytomegalovirus Infections / Q000276:immunology / Q000517:prevention & control*; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000494:pharmacology; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D009894:Opportunistic Infections / Q000276:immunology / Q000517:prevention & control*; D056990:Post-Exposure Prophylaxis; D065129:Pre-Exposure Prophylaxis; D016032:Randomized Controlled Trials as Topic; D014184:Transplantation, Homologous; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir
keywords: antiviral prophylaxis; cytomegalovirus; kidney transplantation; pre-emptive therapy