Extended Low-Dose Valganciclovir Is Effective Prophylaxis Against Cytomegalovirus in High-Risk Kidney Transplant Recipients With Near-Complete Eradication of Late-Onset Disease
| Autor: | R. Lieber, Jennifer Poirier, E. Beshears, J. Geyston, Martin Hertl, M.M. Brokhof, A. Sauer, Sameh A. Fayek, D.M. Simon, Stephen C. Jensik, A.C. Hodowanec, Edward F. Hollinger, N. Alvey, Oyedolamu K. Olaitan |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Congenital cytomegalovirus infection Cytomegalovirus Drug resistance 030230 surgery Gastroenterology Kidney transplant Antiviral Agents 03 medical and health sciences 0302 clinical medicine Postoperative Complications Risk Factors Internal medicine Drug Resistance Viral medicine Humans Valganciclovir Colitis Ganciclovir Retrospective Studies Transplantation business.industry virus diseases Retrospective cohort study Odds ratio Middle Aged medicine.disease Kidney Transplantation Confidence interval Tissue Donors Transplant Recipients Surgery Delayed-Action Preparations Cytomegalovirus Infections 030211 gastroenterology & hepatology Female business medicine.drug |
| Zdroj: | Transplantation proceedings. 48(6) |
| ISSN: | 1873-2623 |
| Popis: | 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.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.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.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. |
| Databáze: | OpenAIRE |
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