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