Impact of Prophylaxis vs Pre-emptive Approach for Cytomegalovirus Infection in Kidney Transplant Recipients.
Cytomegalovirus (CMV) is the most common viral infection during the post-transplant period, and it is one of the major causes of morbidity and mortality in kidney transplantation. In this study, the incidence and impact of pre-emptive and prophylactic approaches and long-term effects on graft and patient survival of CMV infection were investigated. Among 493 adult kidney transplant recipients, pretransplant CMV IgG-negative patients and patients with a follow-up shorter than a month were excluded. The patients were divided into 2 groups: pre-emptive group (n = 187, regular screening and acyclovir 400 mg twice daily for 6 months), and prophylaxis group (n = 275, valganciclovir 450 mg/d for 3 months). The pre-emptive group was screened for CMV with either pp65 antigenemia or CMV DNA. There were 462 patients, and mean follow-up was 37.7 months. There were more CMV infections in the pre-emptive group than in the prophylaxis group (n = 56, 30.1% vs n = 12, 4.4%, respectively; P < .001). Late CMV infections were significantly more frequent in the prophylaxis group (10 of 12, 83.3%) than in the pre-emptive group (8 of 56, 14.3%, P < .001). In multivariate analysis, valganciclovir prophylaxis was associated with a lower CMV infection (relative risk [RR]: 0.18, 95% confidence interval [CI] 0.08 to 0.39, P < .001). Delayed graft function was the only independent risk factor for graft loss during the follow-up on multivariate Cox regression analysis (RR: 2.66, 95% GA 1.17 to 6.04, P = .02). Valganciclovir prophylaxis was more protective against CMV infection than the pre-emptive approach. Neither prophylaxis/pre-emptive approaches nor CMV infection had negative effect on graft and patient survival.
Department of Internal Medicine, Ege University Medical School, Izmir, Turkey.
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Kır
Department of Microbiology, Ege University Medical School, Izmir, Turkey.
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Zeytinoğlu
Department of Infectious Disease, Ege University Medical School, Izmir, Turkey.
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Arda
Division of Nephrology, Ege University Medical School, Izmir, Turkey. Electronic address: mumt@hotmail.com.
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Yılmaz
Division of Nephrology, Ege University Medical School, Izmir, Turkey.
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Aşçı
Division of Nephrology, Ege University Medical School, Izmir, Turkey.
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Töz
D000212:Acyclovir / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D006085:Graft Survival; D006801:Humans; D007674:Kidney Diseases / Q000401:mortality / Q000601:surgery / Q000821:virology; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011292:Premedication / Q000401:mortality; D012307:Risk Factors; D066027:Transplant Recipients; D000077562:Valganciclovir; D055815:Young Adult
D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir; D000212:Acyclovir