Cytomegalovirus prevention strategies in seropositive kidney transplant recipients: an insight into current clinical practice

被引:30
作者
Fernandez-Ruiz, Mario [1 ]
Arias, Manuel [2 ]
Campistol, Josep M. [3 ]
Navarro, David [4 ]
Gomez-Huertas, Ernesto [5 ]
Gomez-Marquez, Gonzalo [6 ]
Manuel Diaz, Juan [7 ]
Hernandez, Domingo [8 ]
Bernal-Blanco, Gabriel [9 ]
Cofan, Frederic [3 ]
Jimeno, Luisa [10 ]
Franco-Esteve, Antonio [11 ]
Gonzalez, Esther [12 ]
Moreso, Francesc J. [13 ]
Gomez-Alamillo, Carlos [2 ]
Mendiluce, Alicia
Luna-Huerta, Enrique [14 ]
Maria Aguado, Jose [1 ]
机构
[1] Hosp Univ 12 Octubre, Infect Dis Unit, Inst Invest Hosp 12 Octubre i 12, Madrid 28041, Spain
[2] Hosp Univ Marques de Valdecilla, Inst Formac & Invest Marques de Valdecilla IFIMAV, Dept Nephrol, Santander, Spain
[3] Hosp Clin Barcelona, Inst Invest Biomed August Pi & Sunyer IDIBAPS, Dept Nephrol, Barcelona, Spain
[4] Univ Valencia, Inst Invest Sanitaria INCLIVA, Hosp Clin Univ, Dept Microbiol, Valencia, Spain
[5] Univ Oviedo, Hosp Cent Asturias, Dept Nephrol, E-33080 Oviedo, Spain
[6] Hosp Univ Son Espases, Dept Nephrol, Palma De Mallorca, Spain
[7] Fundacio Puigvert, Dept Nephrol, Barcelona, Spain
[8] Hosp Univ Carlos Haya, Dept Nephrol, Malaga, Spain
[9] Hosp Univ Virgen del Rocio, Inst Biomed Sevilla IBIS, Dept Nephrol, Seville, Spain
[10] Hosp Univ Virgen de la Arrixaca, Dept Nephrol, Murcia, Spain
[11] Hosp Gen Alicante, Nephrol Unit, Alicante, Spain
[12] Hosp Univ 12 Octubre, Dept Nephrol, Inst Invest Hosp 12 Octubre i 12, Madrid 28041, Spain
[13] Hosp Univ Vall dHebron, Dept Nephrol, Barcelona, Spain
[14] Hosp Univ Infanta Cristina, Dept Nephrol, Badajoz, Spain
关键词
antiviral prophylaxis; cytomegalovirus; kidney transplantation; multicenter study; preemptive therapy; seropositive recipient; SOLID-ORGAN TRANSPLANTATION; VALGANCICLOVIR PROPHYLAXIS; RISK-FACTORS; VIRAL LOAD; ORAL GANCICLOVIR; INFECTION; DISEASE; MANAGEMENT; EFFICACY; MULTICENTER;
D O I
10.1111/tri.12586
中图分类号
R61 [外科手术学];
学科分类号
摘要
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.
引用
收藏
页码:1042 / 1054
页数:13
相关论文
共 45 条
[11]   Is there a change in cytomegalovirus seroepidemiology in Spain? [J].
De Ory F. ;
Ramírez R. ;
García Comas L. ;
León P. ;
Sagües M.J. ;
Sanz J.C. .
European Journal of Epidemiology, 2004, 19 (1) :85-89
[12]   Risk factors associated with cytomegalovirus infection in heart transplant patients: a prospective, epidemiological study [J].
Delgado, J. F. ;
Manito, N. ;
Almenar, L. ;
Crespo-Leiro, M. ;
Roig, E. ;
Segovia, J. ;
Vazquez de Prada, J. A. ;
Lage, E. ;
Palomo, J. ;
Camprecios, M. ;
Arizon, J. M. ;
Rodriguez-Lambert, J. L. ;
Blasco, T. ;
de la Fuente, L. ;
Pascual, D. ;
Rabago, G. .
TRANSPLANT INFECTIOUS DISEASE, 2011, 13 (02) :136-144
[13]   A Direct and Indirect Comparison Meta-Analysis on the Efficacy of Cytomegalovirus Preventive Strategies in Solid Organ Transplant [J].
Florescu, Diana F. ;
Qiu, Fang ;
Schmidt, Cynthia M. ;
Kalil, Andre C. .
CLINICAL INFECTIOUS DISEASES, 2014, 58 (06) :785-803
[14]   The 'Indirect' Effects of Cytomegalovirus Infection [J].
Freeman, R. B., Jr. .
AMERICAN JOURNAL OF TRANSPLANTATION, 2009, 9 (11) :2453-2458
[15]  
Gabardi S, 2015, TRANSPLANTATION
[16]   An International Multicenter Performance Analysis of Cytomegalovirus Load Tests [J].
Hirsch, Hans H. ;
Lautenschlager, Irmeli ;
Pinsky, Benjamin A. ;
Cardenoso, Laura ;
Aslam, Shagufta ;
Cobb, Bryan ;
Vilchez, Regis A. ;
Valsamakis, Alexandra .
CLINICAL INFECTIOUS DISEASES, 2013, 56 (03) :367-373
[18]   The Efficacy and Safety of 200 Days Valganciclovir Cytomegalovirus Prophylaxis in High-Risk Kidney Transplant Recipients [J].
Humar, A. ;
Lebranchu, Y. ;
Vincenti, F. ;
Blumberg, E. A. ;
Punch, J. D. ;
Limaye, A. P. ;
Abramowicz, D. ;
Jardine, A. G. ;
Voulgari, A. T. ;
Ives, J. ;
Hauser, I. A. ;
Peeters, P. .
AMERICAN JOURNAL OF TRANSPLANTATION, 2010, 10 (05) :1228-1237
[19]   Extended Valganciclovir Prophylaxis in D+/R- Kidney Transplant Recipients is Associated With Long-Term Reduction in Cytomegalovirus Disease: Two-Year Results of the IMPACT Study [J].
Humar, Atul ;
Limaye, Ajit P. ;
Blumberg, Emily A. ;
Hauser, Ingeborg A. ;
Vincenti, Flavio ;
Jardine, Alan G. ;
Abramowicz, Daniel ;
Ives, Jane A. L. ;
Farhan, Mahdi ;
Peeters, Patrick .
TRANSPLANTATION, 2010, 90 (12) :1427-1431
[20]   Risk Factors for Late-Onset Cytomegalovirus Infection or Disease in Kidney Transplant Recipients [J].
Jamal, Alainna J. ;
Husain, Shahid ;
Li, Yanhong ;
Famure, Olusegun ;
Kim, S. Joseph .
TRANSPLANTATION, 2014, 97 (05) :569-575