Impact of valganciclovir prophylaxis on the development of severe late-cytomegalovirus disease in high-risk solid organ transplant recipients
| Autor: | Tomás Pumarola, C. Esteva, María José Ricart, Laura Linares, Carlos Cervera, Frederic Cofan, Andrés Antón, Félix Pérez-Villa, M. Navasa, A. Moreno, M.A. Marcos, M. Pineda |
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| Rok vydání: | 2007 |
| Předmět: |
Ganciclovir
Human cytomegalovirus Adult Male medicine.medical_specialty Gastroenterology Antiviral Agents Organ transplantation Postoperative Complications Betaherpesvirinae Transplantation Immunology Internal medicine medicine Humans Valganciclovir Prospective Studies Prospective cohort study Transplantation biology business.industry Incidence virus diseases Organ Transplantation Middle Aged biology.organism_classification medicine.disease Surgery Cytomegalovirus Infections Female Viral disease business Immunosuppressive Agents medicine.drug Follow-Up Studies |
| Zdroj: | TRANSPLANTATION PROCEEDINGS r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu Universidad de las Islas Baleares |
| ISSN: | 0041-1345 |
| Popis: | BACKGROUND: With the introduction of prolonged prophylaxis with valganciclovir in cytomegalovirus (CMV) donor/recipient serodiscordance (D+/R-) patients, concerns about a high incidence of late and invasive CMV disease associated with mortality have emerged. We compared the characteristics of CMV disease in D+/R- patients receiving prolonged valganciclovir prophylaxis with R+ patients. METHODS: We prospectively followed all solid organ transplant recipients from January 2004 to December 2005. CMV prophylaxis with valganciclovir or ganciclovir was administered as follows: donor- recipient serodiscordance (D+/R-), 12 weeks; induction with antithymocyte globulin or acute rejection episodes requiring steroid pulses, 15 to 30 days; and CMV R+ double kidney-pancreas, 15 days. Transplant characteristics and the development of CMV disease variables were collected for all patients. We defined 2 groups according to the risk of CMV disease: CMV donor/recipient mismatch (D+/R-) and recipient CMV-positive (R+) groups. RESULTS: During the study period we performed 481 solid organ transplantations: 237 kidney, 34 kidney-pancreas, 157 liver, 38 heart, 13 liver-kidney, and 2 heart-kidney. Overall, 36 patients developed CMV disease (7.5%). CMV donor-recipient mismatch (D+/R-) was associated with a greater risk of CMV disease compared with CMV-positive recipients (16% vs 7%; P = .036). Prophylaxis against CMV was longer in the D+/R- group (mean days 73 vs 15; P < .001). CMV disease appeared later in the D+/R- than in R+ group (mean days 123 vs 59; P < .001). We observed a trend toward a lower incidence of tissue-invasive CMV disease among the D+/R- group compared with the R+ group without significance (14% vs 41%; P = .382). Three patients died in the first 30 days after the onset of CMV disease, all of them in the R+ group. CONCLUSIONS: In our setting, high-risk patients (D+/R-) receiving prolonged prophylaxis with valganciclovir developed later CMV disease, but this was neither more tissue-invasive nor more life-threatening than in the R+ group. |
| Databáze: | OpenAIRE |
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