Reduction in mortality associated with secondary cytomegalovirus prophylaxis after solid organ transplantation

• Published in: Transplant infectious disease 2018-06, Vol.20 (3), p.e12873-n/a
• Main Authors: Serrano‐Alonso, M., Guillen‐Grima, F., Martin‐Moreno, P., Rabago, G., Manrique, J., Garcia‐del‐Barrio, M., Reina, G., Torre‐Cisneros, J., Fernandez‐Alonso, M., Herrero, J.I.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antiviral Agents; Cohort Studies; Cytomegalovirus; Cytomegalovirus - drug effects; Cytomegalovirus Infections - mortality; Cytomegalovirus Infections - prevention & control; Cytomegalovirus Infections - virology; Female; Ganciclovir; Grafting; Humans; Infections; Kidney Transplantation - adverse effects; Male; Middle Aged; Mortality; Organ Transplantation - adverse effects; outcome; Patients; Prophylaxis; recurrence; Retrospective Studies; Secondary Prevention - methods; Secondary Prevention - statistics & numerical data; secondary prophylaxis; solid organ transplantation; Transplantation; Transplants & implants
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.12873

Background Cytomegalovirus (CMV) is the most important viral pathogen in solid organ transplant (SOT) recipients. The role of secondary CMV prophylaxis in this population remains unclear. Methods Retrospective cohort study in a single center. SOT recipients treated for CMV infection from 2007 to 2014 were studied to determine the efficacy and safety of secondary prophylaxis and its impact on graft loss and mortality. The outcome variable was CMV replication in the first 3 months after the end of therapy. Secondary variables were crude mortality and graft lost censored at 5 years after transplantation. Propensity score for the use of secondary prophylaxis was used to control selection bias. Results Of the 126 treated patients, 103 (83.1%) received CMV secondary prophylaxis. CMV relapse occurred in 44 (35.5%) patients. The use of secondary prophylaxis was not associated with fewer relapses (34.0% in patients with prophylaxis vs 42.9% in those without prophylaxis, P = .29). After a mean follow‐up of 32.1 months, graft loss was not different between both groups but patient mortality was significantly lower in patients who received secondary prophylaxis (5.8% vs 28.6%, P = .003). Conclusion Secondary prophylaxis did not prevent CMV infection relapse but it was associated with improved patient survival.