Impact of valganciclovir prophylaxis duration on cytomegalovirus disease in high‐risk donor seropositive/recipient seronegative heart transplant recipients
| Autor: | Hannah Imlay, Allison O. Dumitriu Carcoana, Beatrice Wong, Ajit P. Limaye, Daniel P. Fishbein, Robert M. Rakita, Cynthia E. Fisher |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Congenital cytomegalovirus infection Disease 030230 surgery Antiviral Agents Gastroenterology Article 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine medicine Humans Valganciclovir Retrospective Studies Heart transplantation Transplantation Kidney Lung business.industry Incidence Incidence (epidemiology) Confounding Middle Aged medicine.disease Tissue Donors Transplant Recipients Infectious Diseases medicine.anatomical_structure Cytomegalovirus Infections Heart Transplantation Female 030211 gastroenterology & hepatology business medicine.drug |
| Zdroj: | Transpl Infect Dis |
| ISSN: | 1399-3062 1398-2273 |
| DOI: | 10.1111/tid.13255 |
| Popis: | BACKGROUND: Few data support current guideline recommendations for 6 months over 3 months of antiviral prophylaxis for cytomegalovirus (CMV) disease prevention in donor seropositive/recipient seronegative (D+R-) heart transplant recipients (HTR). METHODS: We retrospectively assessed CMV disease and clinical outcomes in 310 adult HTR between 7/5/2005 – 12/30/2016 at a single center. Valganciclovir (VGCV) prophylaxis was given for 3 months in recipient seropositive (R+) and for 3 to 6 months in D+R- groups. A multivariable logistic model evaluated risk factors for CMV disease, with use of inverse probability weighting to correct for confounding. A nested matched cohort study within D+R- HTR was performed to assess CMV disease-associated morbidity. Chi-square and Mann-Whitney tests compared categorical and continuous variables, with p < 0.05 considered significant. RESULTS: The incidence of CMV disease among all, D+R-, and R+ groups was 8.7% (27/310), 26.5% (22/83), and 2.8% (5/180), respectively, and included syndrome in 22.2% (6/27) and end-organ involvement in 77.8% (21/27). In multivariable models, longer prophylaxis duration was not associated with reduced risk for CMV disease when assessed either as a continuous (p=0.28) or categorical (3 vs 6 months) variable (p=0.19). CMV disease in D+R- HTR was associated with higher rates of hospitalization (87.5% [14/16] vs 6.3% [1/16], p |
| Databáze: | OpenAIRE |
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