Kidney transplantation
Complication
The Effect of Cytomegalovirus Antigenemia Titer on the Efficacy of Preemptive Therapy for the Prevention of Cytomegalovirus Disease After Kidney Transplantation

https://doi.org/10.1016/j.transproceed.2010.02.040Get rights and content

Abstract

There is some controversy regarding the exact cytomegalovirus (CMV) antigenemia titer that should be used as a guideline for preemptive anti-CMV therapy. We performed 634 consecutive kidney transplantations between January 2000 and June 2007. Preemptive therapy employed intravenous gancyclovir treatment when the CMV antigenemia titer was ≥50/4 × 105 leukocytes after kidney transplantation. The 634 recipients were allocated into 2 groups according to the peak CMV antegenemia: group A, CMV antigenemia titer <50/4 × 105 (n = 550); and group B, ≥50/40 × 105 (n = 84).

Among the 634 recipients, 264 were positive for CMV antigenemia, and 61 developed symptomatic CMV infections. The incidence of symptomatic CMV infections in group B was significantly higher than in group A. Two cases in both groups developed tissue-proven CMV disease: group A CMV colitis and CMV nephritis, and group B, 2 cases of CMV colitis. Graft and patient survival rates in groups A and B at 5 years posttransplantation were not different.

The authors concluded that a CMV antigenemia titer of ≥50/4 × 105 leukocytes can be considered an appropriate guideline for preemptive anti-CMV therapy.

Section snippets

Patients

Between January 2000 and June 2007, we performed 634 consecutive kidney transplantations: 505 living donor and 129 deceased donor procedures. They were all observed until June 2008.

Study Design

The 634 consecutive kidney transplant recipients were divided into 2 groups according to the peak titer level of CMV antigenemia during CMV infections. Patients with were assigned to group A (n = 550) or B (n = 84) based on a CMV antigenemia titer of <50 or ≥50/4 × 105 leukocytes, respectively. Since January 2000,

Patient Characteristics

From January 2000 to June 2007, we performed 634 consecutive kidney transplantations. All recipients were followed for at least 1 year. Their demographic characteristics are shown in Table 1.

Comparison of Group Preoperative Variables

Deceased donor kidney transplant cases and use of ATG for induction therapy before kidney transplantation were significantly greater in group B than group A: 40.4% versus 17.2%, and 46.5% versus 9.6%, respectively. The duration of CMV antigenemia (≥50/4 × 105 leukocytes) in group B members who were

Discussion

Human CMV is one of the most important opportunistic pathogens in immunocompromised patients. Primary infections occur in 70%–88% of CMV antibody-negative recipients from CMV antibody-positive donors, whereas, CMV reinfection or reactivation occurs in 50%–80% of CMV antibody-positive recipients from CMV antibody-positive donors.11 Moreover, according to Korean reports, CMV infections occur in 36.6%–60.8% of CMV antibody-positive recipients from antibody-positive donors.12, 13 The overall

References (31)

  • R.H. Rubin

    Preemptive therapy in immunocompromised hosts

    N Engl J Med

    (1991)
  • M.E. Falagas et al.

    Exposure to cytomegalovirus from the donated organ is a risk factor for bacteremia in orthotopic liver transplant recipientsBoston Center for Liver Transplantation CMVIG Study Group

    Clin Infect Dis

    (1996)
  • C. Couchoud et al.

    Cytomegalovirus prophylaxis with antiviral agents in solid organ transplantation: a meta-analysis

    Transplantation

    (1998)
  • N. Singh

    Preemptive therapy versus universal prophylaxis with ganciclovir for cytomegalovirus in solid organ transplant recipients

    Clin Infect Dis

    (2001)
  • S. Kusne et al.

    Cytomegalovirus PP65 antigenemia monitoring as a guide for preemptive therapy: a cost effective strategy for prevention of cytomegalovirus disease in adult liver transplant recipients

    Transplantation

    (1999)
  • Cited by (7)

    • Clinical correlates of pp65 antigenemia monitoring in the first months of post kidney transplant in patients undergoing universal prophylaxis or preemptive therapy

      2017, Brazilian Journal of Infectious Diseases
      Citation Excerpt :

      The positivity of pp65 antigenemia test can precede clinical symptoms; therefore, it is a useful tool to promptly support clinical decisions and has been considered the gold standard for monitoring HCMV viral replication in solid organ transplant recipients.9,16,17 The mean age of the donors was similar to other studies,18,19 and the positivity rate of IgG anti-HCMV was 100%. More importantly, the analyzed parameters did not differ between groups.

    • The effects of preemptive therapy using a very low threshold of pp65 antigenemia to prevent cytomegalovirus disease in kidney transplant recipients: A single-center experience

      2013, Transplantation Proceedings
      Citation Excerpt :

      Furthermore, the most important result was that none of the patients developed CMV symptomatic disease, a result that has not been always reached in those studies that started antiviral treatment at higher levels of pp65 CMV antigenemia.8 In a previous study, Jung et al9 divided a large cohort of kidney transplant patients into 2 groups according to their peak CMV antigenemia titer, namely <50/4 × 104 versus ≥50/4 × 104 leukocytes. They observed patient and graft survivals at 5 years posttransplantation to be similar in the 2 groups, concluding that a CMV antigenemia ≥50/4 × 104 leukocytes can be considered an appropriate guideline for preemptive anti-CMV therapy.

    View all citing articles on Scopus
    View full text