Preemptive Therapy Versus Valgancyclovir Prophylaxis in Cytomegalovirus-positive Kidney Transplant Recipients Receiving Antithymocyte Globulin Induction

• Published in: Transplantation proceedings 2012-11, Vol.44 (9), p.2809-2813
• Main Authors: Couzi, L, Helou, S, Bachelet, T, Martin, S, Moreau, K, Morel, D, Lafon, M.E, Garrigue, I, Merville, P
• Format: Article
• Language: English
• Subjects: Acute Disease; Aged; Aged, 80 and over; Antilymphocyte Serum - adverse effects; Antiviral Agents - administration & dosage; Biological and medical sciences; Chi-Square Distribution; Cytomegalovirus Infections - diagnosis; Cytomegalovirus Infections - immunology; Cytomegalovirus Infections - mortality; Cytomegalovirus Infections - prevention & control; Drug Administration Schedule; Female; France - epidemiology; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Ganciclovir - administration & dosage; Ganciclovir - analogs & derivatives; Graft Rejection - epidemiology; Graft Rejection - immunology; Graft Survival; Humans; Immunosuppressive Agents - adverse effects; Incidence; Kidney Transplantation - adverse effects; Kidney Transplantation - immunology; Kidney Transplantation - mortality; Male; Medical sciences; Middle Aged; Opportunistic Infections - epidemiology; Opportunistic Infections - immunology; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; Risk Factors; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Tissue, organ and graft immunology; Treatment Outcome
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2012.09.029

Abstract International consensus guidelines on the management of cytomegalovirus (CMV) infections in kidney transplantation recommend the use of universal prophylaxis over preemptive therapy for the highest risk kidney transplant recipients (KTR), namely donor+/recipient – CMV serostatus. However, no universal recommendations have been made for R+ KTR undergoing antithymocyte globulin (ATG) induction. In this retrospective study, we compared 1-year outcomes among 24 R+ KTR who received 3 months of valgancyclovir prophylaxis with 72 R+ KTR who were subjected to a preemptive strategy. All subjects received ATG induction. The incidence of CMV infection was significantly higher among the preemptive subjects versus the prophylaxis group (78% versus 38%, respectively; P = .0003), whereas the incidence of CMV disease was low and did not differ significantly between the cohorts (8% versus 7% respectively, P = .8). Late-onset CMV infections were only observed in the prophylaxis group (25% versus 0%, P = .0001). Finally, the rate of opportunistic infections, acute rejection episodes, and graft/patient survivals at 1 year were also similar between the two groups. In light of this study, preemptive therapy and universal prophylaxis were almost equally effective to prevent CMV infection among R+ KTR receiving ATG induction.