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Preemptive anti-cytomegalovirus therapy in high-risk (donor-positive, recipient-negative cytomegalovirus serostatus) kidney transplant recipients.
- Source :
-
International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases [Int J Infect Dis] 2017 Dec; Vol. 65, pp. 50-56. Date of Electronic Publication: 2017 Oct 03. - Publication Year :
- 2017
-
Abstract
- Objectives: Universal prophylaxis and preemptive therapy are used to prevent cytomegalovirus (CMV) disease post-transplantation. Data regarding which strategy is superior are sparse, especially in high-risk recipients (donor CMV seropositive (D+) and recipient CMV seronegative (R-)).<br />Methods: This retrospective, single-center cohort study included recipients who underwent kidney transplantation between 2009 and 2015. The incidence of CMV infection/disease and patient and graft outcomes were analyzed and compared between high-risk recipients (D+/R-) and intermediate-risk recipients (D+/R+ or D-/R+), all managed with preemptive therapy.<br />Results: Of 118 kidney transplant recipients, 21 were high-risk and 97 were intermediate-risk. Over a median follow-up period of 3 years, asymptomatic CMV infection developed significantly more frequently in high-risk patients than in intermediate-risk patients (38.1% vs. 16.5%, p=0.04), and CMV disease developed in a similar manner (28.6% vs. 3.1%, p<0.01). Among high-risk patients, CMV infection developed within the first 3 months post-transplantation and CMV disease within the first 9 months post-transplantation. Kaplan-Meier analysis showed no difference in the probability of mortality (log-rank p=0.63) or graft loss (log-rank p=0.50) between the patient groups. Graft rejection occurred more frequently in high-risk than in intermediate-risk patients, but the difference was not significant (log-rank p=0.24).<br />Conclusions: These results suggest that further studies on universal prophylaxis in high-risk patients are needed to elucidate whether preventing CMV infection/disease during the early post-transplant period leads to better outcomes, especially in terms of reducing graft rejection.<br /> (Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
- Subjects :
- Adult
Antibodies, Monoclonal therapeutic use
Basiliximab
Cytomegalovirus
Cytomegalovirus Infections drug therapy
Female
Follow-Up Studies
Graft Rejection prevention & control
Graft Rejection virology
Humans
Immunosuppressive Agents therapeutic use
Incidence
Kaplan-Meier Estimate
Male
Methylprednisolone therapeutic use
Middle Aged
Mycophenolic Acid therapeutic use
Recombinant Fusion Proteins therapeutic use
Retrospective Studies
Ribonucleosides therapeutic use
Risk Factors
Rituximab therapeutic use
Tacrolimus therapeutic use
Tissue Donors
Treatment Outcome
Antiviral Agents therapeutic use
Cytomegalovirus Infections prevention & control
Kidney Transplantation
Subjects
Details
- Language :
- English
- ISSN :
- 1878-3511
- Volume :
- 65
- Database :
- MEDLINE
- Journal :
- International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases
- Publication Type :
- Academic Journal
- Accession number :
- 28986314
- Full Text :
- https://doi.org/10.1016/j.ijid.2017.09.023