title: Effect of Cytomegalovirus Infection on Survival of Older Kidney Transplant Patients (D+/R+): Impact of Valganciclovir Prophylaxis Versus Preemptive Therapy.
abstract: BACKGROUND
  Kidney transplant patients with D+/R+ serology can be treated with either prophylaxis or preemptive valganciclovir. The older transplant population suffers severe immunosenescence, especially patients with latent cytomegalovirus (CMV) infection (R+). They are more likely to develop indirect CMV effects. Likewise, many patients have significant cardiovascular comorbidity, which makes them more sensitive to these indirect effects. The aim of this study was to evaluate the incidence of CMV viremia and indirect effects on survival, comparing prophylaxis (V) against preemptive (P) valganciclovir in an older kidney transplant population.
  
  
  METHODS
  We analyzed the data of 233 recipients from 2002 (age, >55 years; D+/R+) with ≥6 months of follow-up. The patients were divided into 2 groups: 167 (71.7%) in the V group and 66 (28.3%) in the P group.
  
  
  RESULTS
  The incidence of CMV infection in the P group was 32% versus 6% in V group. Patients with CMV viremia showed worse survival values than patients without viremia (log rank P = .031). Five-year survivals were 74% vs 88%, respectively. Cox regression showed that the adjusted effect of CMV infection on overall survival was a significant risk (hazard ratio [HR], 2.07; 95% CI, 1.003-4.29). Patients with CMV viremia showed worse cardiovascular survival than patients without viremia, with 5-year survivals of 79% vs 94%. Cox regression showed that the adjusted effect of CMV infection was a significant risk (HR, 2.62).
  
  
  CONCLUSIONS
  CMV infection has a detrimental effect on the survival of older patients. Valganciclovir prophylaxis induces a protective effect against CMV infection and could improve survival of older patients with cardiovascular comorbidities.
authors.affiliation: Nephrology and Kidney Transplantation Department, Infanta Cristina Hospital, Badajoz, Spain. Electronic address: docencianefrohic@yahoo.es.
authors.forename: E
authors.initials: E
authors.lastname: Luna
authors.affiliation: Nephrology and Kidney Transplantation Department, Infanta Cristina Hospital, Badajoz, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Caravaca
authors.affiliation: Nephrology and Kidney Transplantation Department, Infanta Cristina Hospital, Badajoz, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Ferreira
authors.affiliation: Nephrology Department, Hospital de Mérida, Badajoz, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Fernandez
authors.affiliation: Department of Microbiology, Infanta Cristina Hospital, Badajoz, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Martín
authors.affiliation: Department of Inmunology, Infanta Cristina Hospital, Badajoz, Spain.
authors.forename: M L
authors.initials: ML
authors.lastname: Vargas
authors.affiliation: Department of Pathology, Infanta Cristina Hospital, Badajoz, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Saenz de Santamaría
authors.affiliation: Nephrology and Kidney Transplantation Department, Infanta Cristina Hospital, Badajoz, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Garcia Pino
authors.affiliation: Nephrology and Kidney Transplantation Department, Infanta Cristina Hospital, Badajoz, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Azevedo
authors.affiliation: Nephrology and Kidney Transplantation Department, Infanta Cristina Hospital, Badajoz, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Muñoz Sanz
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000401:mortality / Q000517:prevention & control*; D004812:Epidemiologic Methods; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013997:Time Factors; D000077562:Valganciclovir; D014766:Viremia / Q000209:etiology / Q000401:mortality / Q000517:prevention & control
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir