Cytomegalovirus prevention strategies in seropositive kidney transplant recipients: an insight into current clinical practice
Mario Fernández-Ruiz, Manuel Arias, Josep M Campistol, David Navarro, Ernesto Gómez-Huertas, Gonzalo Gómez-Márquez, Juan Manuel Díaz, Domingo Hernández, Gabriel Bernal-Blanco, Frederic Cofan, Luisa Jimeno, Antonio Franco-Esteve, Esther González, Francesc J Moreso, Carlos Gómez-Alamillo, Alicia Mendiluce, Enrique Luna-Huerta, José María Aguado, OPERA Study Group, Manuel Arias, Carlos Gómez Alamillo, Josep Maria Campistol, Federico Cofán, José María Aguado, Esther González, Mario Fernández Ruiz, David Navarro, Ernesto Gómez Huertas, Gonzalo Gómez Márquez, Juan Manuel Díaz, Domingo Hernández, Eugenia Sola, Gabriel Bernal Blanco, Luisa Jimeno, Antonio Franco Esteve, Francisco Moreso, Alicia Mendiluce, Enrique Luna Huerta, María Ovidia López Oliva, Isabel Beneyto, Paloma Martín, Francisco Llamas Fuente, Alex Gutiérrez, Teresa García Álvarez, Rita Guerra Rodríguez, Natividad Calvo, Ana Fernández Rodríguez, José Matías Tabernero Romo, María Dolores Navarro, Ana Ramos Verde, Mario Fernández-Ruiz, Manuel Arias, Josep M Campistol, David Navarro, Ernesto Gómez-Huertas, Gonzalo Gómez-Márquez, Juan Manuel Díaz, Domingo Hernández, Gabriel Bernal-Blanco, Frederic Cofan, Luisa Jimeno, Antonio Franco-Esteve, Esther González, Francesc J Moreso, Carlos Gómez-Alamillo, Alicia Mendiluce, Enrique Luna-Huerta, José María Aguado, OPERA Study Group, Manuel Arias, Carlos Gómez Alamillo, Josep Maria Campistol, Federico Cofán, José María Aguado, Esther González, Mario Fernández Ruiz, David Navarro, Ernesto Gómez Huertas, Gonzalo Gómez Márquez, Juan Manuel Díaz, Domingo Hernández, Eugenia Sola, Gabriel Bernal Blanco, Luisa Jimeno, Antonio Franco Esteve, Francisco Moreso, Alicia Mendiluce, Enrique Luna Huerta, María Ovidia López Oliva, Isabel Beneyto, Paloma Martín, Francisco Llamas Fuente, Alex Gutiérrez, Teresa García Álvarez, Rita Guerra Rodríguez, Natividad Calvo, Ana Fernández Rodríguez, José Matías Tabernero Romo, María Dolores Navarro, Ana Ramos Verde
Abstract
There is notable heterogeneity in the implementation of cytomegalovirus (CMV) prevention practices among CMV-seropositive (R+) kidney transplant (KT) recipients. In this prospective observational study, we included 387 CMV R+ KT recipients from 25 Spanish centers. Prevention strategies (antiviral prophylaxis or preemptive therapy) were applied according to institutional protocols at each site. The impact on the 12-month incidence of CMV disease was assessed by Cox regression. Asymptomatic CMV infection, acute rejection, graft function, non-CMV infection, graft loss, and all-cause mortality were also analyzed (secondary outcomes). Models were adjusted for a propensity score (PS) analysis for receiving antiviral prophylaxis. Overall, 190 patients (49.1%) received preemptive therapy, 185 (47.8%) antiviral prophylaxis, and 12 (3.1%) no specific intervention. Twelve-month cumulative incidences of CMV disease and asymptomatic infection were 3.6% and 39.3%, respectively. Patients on prophylaxis had lower incidence of CMV disease [PS-adjusted HR (aHR): 0.10; 95% confidence interval (CI): 0.01-0.79] and asymptomatic infection (aHR: 0.46; 95% CI: 0.29-0.72) than those managed preemptively, with no significant differences according to the duration of prophylaxis. All cases of CMV disease in the prophylaxis group occurred after prophylaxis discontinuation. There were no differences in any of the secondary outcomes. In conclusion, antiviral prophylaxis was associated with a lower occurrence of CMV disease in CMV R+ KT recipients, although such benefit should be balanced with the risk of late-onset disease.
Keywords: antiviral prophylaxis; cytomegalovirus; kidney transplantation; multicenter study; preemptive therapy; seropositive recipient.
© 2015 Steunstichting ESOT.
Source: PubMed