Prevention strategies for cytomegalovirus disease and long-term outcomes in the high-risk transplant patient (D+/R−): experience from the RESITRA-REIPI cohort

• Published in: Transplant infectious disease 2014-06, Vol.16 (3), p.387-396
• Main Authors: Meije, Y., Fortún, J., Len, Ó., Aguado, J.M., Moreno, A., Cisneros, J.M., Gurguí, M., Carratalà, J., Muñoz, P., Montejo, M., Blanes, M., Bou, G., Pérez, J.L., Torre-Cisneros, J., Ramos, A., Pahissa, A., Gavaldà, J.
• Format: Article
• Language: English
• Subjects: Adult; Antiviral Agents - pharmacology; Cohort Studies; Cytomegalovirus; Cytomegalovirus - physiology; Cytomegalovirus Infections - etiology; Cytomegalovirus Infections - prevention & control; D+/R; Female; Ganciclovir - analogs & derivatives; Ganciclovir - pharmacology; graft dysfunction; Humans; Immunosuppressive Agents; Kidney Transplantation - adverse effects; Liver Transplantation - adverse effects; Male; Middle Aged; preemptive therapy; Risk Factors; transplantation; universal prophylaxis; Virus Replication; Young Adult
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.12226

Background Cytomegalovirus (CMV)‐negative recipients of a graft from a CMV‐positive donor (D+/R−) are at high risk of CMV disease. Current preventive strategies include universal prophylaxis (UP) and preemptive therapy (PT). However, the best strategy to prevent CMV disease and achieve better long‐term outcomes remains a matter of debate. Methods We analyzed the incidence of CMV disease and long‐term outcomes including graft dysfunction and patient mortality at 5 years after transplantation with both preventive strategies. High‐risk (D+/R−) kidney and liver transplant recipients from the RESITRA cohort were included. Results Of 2410 kidney or liver transplant patients, 195 (8.3%) were D+/R−. The final cohort included 58 liver and 102 kidney recipients. UP was given in 92 patients and 68 received PT; 10.9% and 36.8% developed CMV disease, respectively (P