Extended Low-Dose Valganciclovir Is Effective Prophylaxis Against Cytomegalovirus in High-Risk Kidney Transplant Recipients With Near-Complete Eradication of Late-Onset Disease

被引：9

作者：

Fayek, S. A. ^{[1
,2
,3
]}

Beshears, E. ^{[3
]}

Lieber, R. ^{[3
]}

Alvey, N. ^{[3
]}

Sauer, A. ^{[3
]}

Poirier, J. ^{[3
]}

Hollinger, E. F. ^{[3
]}

Olaitan, O. K. ^{[3
]}

Jensik, S. ^{[3
]}

Geyston, J. ^{[3
]}

Brokhof, M. M. ^{[3
]}

Hodowanec, A. C. ^{[3
]}

Hertl, M. ^{[3
]}

Simon, D. M. ^{[3
]}

机构：

[1] Ft Worth Transplant Inst, Plaza Med Ctr, Transplant Surg, Ft Worth, TX USA

[2] Cairo Univ, Dept Surg, Fac Med, Cairo, Egypt

[3] Rush Univ, Med Ctr, Chicago, IL 60612 USA

来源：

TRANSPLANTATION PROCEEDINGS | 2016年 / 48卷 / 06期

关键词：

GANCICLOVIR; EFFICACY; IMPACT; SAFETY; CMV;

D O I：

10.1016/j.transproceed.2016.05.004

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Background. Cytomegalovirus (CMV)-seronegative kidney transplant (KTx) recipients of organs from CMV-seropositive donors (D+/R-) are at increased risk for CMV infection. Despite valganciclovir (VGCV) prophylaxis (900 mg daily for 200 days), late onset CMV (LO-CMV) occurs at excessive rates. VGCV-associated cost and toxicities remain problematic. Methods. We retrospectively evaluated 50 D+/R- adult KTx recipients from August 2008 to August 2014 who received low-dose VGCV (450 mg daily) prophylaxis for an extended duration. The primary outcome was occurrence of CMV disease. Results. All patients received depletion induction and underwent ABO-compatible KTx. Mean prophylaxis and follow-up durations were 22.8 and 40.7 months, respectively. Eight patients developed CMV: 5 breakthrough cases (1 case of colitis [2%] and 4 cases of infection [8%]) and 3 cases of LO-CMV (1 syndrome [2.9%] and 2 cases of infection [5.7%]). On logistic regression, longer duration of VGCV prophylaxis was protective against CMV infection or disease (P =.044; odds ratio, 1.12 [95% confidence interval, 1.03-1.29]). None of 19 recipients with prophylaxis for >= 12 months developed LO-CMV compared with 3 of 16 recipients with prophylaxis for <12 months (18.8%) (P =.086). Four patients had recurrence of CMV, and 1 patient developed resistance. CMV was not responsible for graft or patient loss and did not affect survival. Conclusions. Low-dose VGCV is an effective prophylaxis for D+/R- KTx recipients despite depleting induction. Longer prophylaxis is more protective, and receiving VGCV for >= 12 months nearly eradicated LO-CMV without increasing antiviral resistance.

引用

页码：2056 / 2064

页数：9