title: Prophylactic CMV therapy does not improve three-yr patient and graft survival compared to preemptive therapy.
abstract: Despite increasing evidence in favor of prophylactic valganciclovir treatment in kidney transplant recipients for the prevention of cytomegalovirus (CMV) infection, the impact of preemptive vs. prophylactic treatment on long-term clinical outcomes is unclear. In this retrospective study, 187 kidney transplant recipients with serologic intermediate-risk constellation (recipient CMV IgG positive) received either preemptive or prophylactic treatment with valganciclovir. Patient survival (primary endpoint), graft survival, viremia rates, and other CMV-related outcomes were analyzed. Prophylactic therapy reduced the rates for CMV viremia during the first year (hazard ratio: 0.48, 95% confidence interval [CI] 0.30-0.75; p < 0.001). There was a trend for higher three-yr patient mortality in the prophylactic group (hazard ratio: 5.08, 95% CI 0.62-41.3; p = 0.091), and the rate of graft loss was not reduced (hazard ratio: 0.93, 95% CI 0.32-2.68; p = 0.894). Estimated glomerular filtration rate over three yr was on average 6.8 mL/min/1.73 m(2) lower in the prophylactic group (95% CI -11.68 to -1.81; p = 0.007) using a multivariate random effects model but showed more improvement over time. Prophylactic valganciclovir treatment reduced the rate of CMV infections during the first year post-transplant but no effects of prophylactic treatment on patient and graft survival or kidney function over three yr were observed.
authors.affiliation: Clinical Division of Nephrology and Dialysis, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.
authors.forename: Johannes
authors.initials: J
authors.lastname: Werzowa
authors.affiliation: Clinical Division of Nephrology and Dialysis, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Schwaiger
authors.affiliation: Clinical Division of Nephrology and Dialysis, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.
authors.forename: Manfred
authors.initials: M
authors.lastname: Hecking
authors.affiliation: Division of Clinical Virology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Robert
authors.initials: R
authors.lastname: Strassl
authors.affiliation: Department of Medicine 1, Kaiser-Franz-Josef-Spital, Vienna, Austria.
authors.forename: Sabine
authors.initials: S
authors.lastname: Schmaldienst
authors.affiliation: Clinical Division of Nephrology and Dialysis, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.
authors.forename: Georg A
authors.initials: GA
authors.lastname: Böhmig
authors.affiliation: Mannheim Institute of Public Health, Social and Preventive Medicine, University of Heidelberg, Heidelberg, Germany.|BGStats Consulting, Vienna, Austria.
authors.forename: Bernd
authors.initials: B
authors.lastname: Genser
authors.affiliation: Clinical Division of Nephrology and Dialysis, Department of Medicine 3, Medical University of Vienna, Vienna, Austria.
authors.forename: Marcus D
authors.initials: MD
authors.lastname: Säemann
mesh_terms: D019072:Antibiotic Prophylaxis; D000998:Antiviral Agents / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000472:pathogenicity; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000998:Antiviral Agents
keywords: CMV; kidney transplantation; preemptive therapy; prophylactic therapy; valganciclovir