title: Clinical correlates of pp65 antigenemia monitoring in the first months of post kidney transplant in patients undergoing universal prophylaxis or preemptive therapy.
abstract: BACKGROUND
  Human cytomegalovirus is a major cause of morbidity in kidney transplant patients.
  
  
  OBJECTIVE
  We aimed to study viral replication and serological response in the first months post kidney transplant in patients undergoing universal prophylaxis or preemptive therapy and correlate the findings with the clinical course of Human cytomegalovirus infection.
  
  
  METHODS
  Independent from the clinical strategy adopted for managing Human cytomegalovirus infection, prophylaxis versus preemptive therapy, the pp65 antigenemia assay and serological response were assessed on the day of transplantation, and then weekly during the first three months of post-transplant.
  
  
  RESULTS
  From the 32 transplant recipients, 16 were positive for pp65 antigenemia, with a similar incidence rate in each group. There were no positive results in the first three weeks of monitoring; the positivity rate peaked at week eight. There was a trend for a higher and earlier frequency of positivity in the universal prophylaxis group in which the course of the Human cytomegalovirus infection was also more severe. Despite the differences in clinical picture and in the initial immunosuppressant schedule, the serological response was similar in both groups.
  
  
  CONCLUSIONS
  Routine monitoring during the first three post-transplant months has a positive impact on the early detection of Human cytomegalovirus viral replication allowing for timely treatment in order to reduce morbidity of the disease. The strategy of universal therapy employing intravenous ganciclovir was associated to a worse clinical course of the Human cytomegalovirus infection suggesting that the use of >10 cells/2×105leukocytes as a cut-off in this setting may be inappropriate.
authors.affiliation: Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Laboratório Multiusuário de Apoio a Pesquisa em Nefrologia e Ciências Médicas, Niterói, RJ, Brazil.
authors.forename: Fabiana Rabe
authors.initials: FR
authors.lastname: Carvalho
authors.affiliation: Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Laboratório Multiusuário de Apoio a Pesquisa em Nefrologia e Ciências Médicas, Niterói, RJ, Brazil.
authors.forename: Rachel Ingrid Juliboni
authors.initials: RI
authors.lastname: Cosendey
authors.affiliation: Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Laboratório Multiusuário de Apoio a Pesquisa em Nefrologia e Ciências Médicas, Niterói, RJ, Brazil.
authors.forename: Cintia Fernandes
authors.initials: CF
authors.lastname: Souza
authors.affiliation: Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Laboratório Multiusuário de Apoio a Pesquisa em Nefrologia e Ciências Médicas, Niterói, RJ, Brazil.
authors.forename: Thalia
authors.initials: T
authors.lastname: Medeiros
authors.affiliation: Universidade Federal Fluminense, Departamento de Medicina Interna, Nefrologia, Niterói, RJ, Brazil.
authors.forename: Paulo Alexandre
authors.initials: PA
authors.lastname: Menezes
authors.affiliation: Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Laboratório Multiusuário de Apoio a Pesquisa em Nefrologia e Ciências Médicas, Niterói, RJ, Brazil; Universidade Federal Fluminense, Faculdade de Medicina, Departamento de Patologia, Niterói, RJ, Brazil.
authors.forename: Andrea Alice
authors.initials: AA
authors.lastname: Silva
authors.affiliation: Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Laboratório Multiusuário de Apoio a Pesquisa em Nefrologia e Ciências Médicas, Niterói, RJ, Brazil; Universidade Federal Fluminense, Departamento de Medicina Interna, Nefrologia, Niterói, RJ, Brazil. Electronic address: jorgereis@id.uff.br.
authors.forename: Jorge Reis
authors.initials: JR
authors.lastname: Almeida
authors.affiliation: Universidade Federal Fluminense, Hospital Universitário Antônio Pedro, Laboratório Multiusuário de Apoio a Pesquisa em Nefrologia e Ciências Médicas, Niterói, RJ, Brazil; Universidade Federal Fluminense, Departamento de Medicina Interna, Nefrologia, Niterói, RJ, Brazil.
authors.forename: Jocemir Ronaldo
authors.initials: JR
authors.lastname: Lugon
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000517:prevention & control*; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D015166:Monitoring, Immunologic / Q000379:methods*; D010750:Phosphoproteins / Q000097:blood*; D011183:Postoperative Complications / Q000517:prevention & control; D011184:Postoperative Period; D065129:Pre-Exposure Prophylaxis / Q000379:methods*; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014763:Viral Matrix Proteins / Q000097:blood*; D014779:Virus Replication
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D007166:Immunosuppressive Agents; D010750:Phosphoproteins; D014763:Viral Matrix Proteins; C065418:cytomegalovirus matrix protein 65kDa; D015774:Ganciclovir
keywords: Cytomegalovirus; Kidney transplant; Preemptive therapy; Universal prophylaxis; pp65 antigenemia