Elsevier

Transplantation Proceedings

Volume 44, Issue 9, November 2012, Pages 2809-2813
Transplantation Proceedings

11th congress of the french speaking society of transplantation
Kidney transplantation: Complications
Preemptive Therapy Versus Valgancyclovir Prophylaxis in Cytomegalovirus-positive Kidney Transplant Recipients Receiving Antithymocyte Globulin Induction

https://doi.org/10.1016/j.transproceed.2012.09.029Get rights and content

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.

Section snippets

Study Design and Patients

This retrospective study screened all (n = 570) patients who underwent kidney transplantation in our department between January 1, 2005, and November 30, 2009. The 30 KTR who were included in another clinical trial with mandatory antiviral therapy were excluded from the analysis. From January 1, 2005, to November 30, 2006, 107 of 172 kidney transplant patients were R+ KTR, including 24 who received ATG induction (thymoglobulin, genzyme) which was targeted to obtain a T-cell count below 20/mm3

Baseline Characteristics of Patients

Overall, 96 R+ KTR undergoing ATG induction were included in this retrospective study (Table 1). No significant differences were observed among the baseline characteristics of the prophylaxis versus the preemptive groups, except for donor age and donor type.

CMV Manifestations

The incidence of CMV infections over 12 months after transplantation was significantly higher in the preemptive than the prophylaxis group (78% versus 38%, respectively; P = .0003), whereas the low percentages of CMV disease were not

Discussion

The results of our study comparing the efficacy of prophylaxis and preventive treatment in R+/ATG KTR complement the findings of a recently published phase III randomized clinical trial in R+ KTR,29 and two previous retrospective sequential cohort studies in R+ KTR, wherein some patients had undergone ATG induction.30, 31 In these two studies, the authors observed lower incidences of both CMV infections and disease among R+ KTR receiving valgancyclovir prophylaxis. In contrast, we noted a

Acknowledgments

We thank Catherine Rio for her help as a nurse coordinator and the technicians from the Laboratory of Virology at Bordeaux Hospital for CMV monitoring.

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