Cytomegalovirus disease in African-American kidney transplant patients
| Autor: | V. Mave, Mary Killackey, Jennifer McGee, Joseph F. Buell, Rubin Zhang, Lotuce Lee Hamm, Douglas P. Slakey, C. L. Yau, Anil Paramesh |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2012 |
| Předmět: |
Ganciclovir
Adult Graft Rejection Male medicine.medical_specialty Gastroenterology Antiviral Agents Article Immunocompromised Host Risk Factors Internal medicine medicine Humans Cumulative incidence Kidney transplantation Transplantation business.industry Incidence (epidemiology) virus diseases Valganciclovir Odds ratio Middle Aged medicine.disease Kidney Transplantation Black or African American Infectious Diseases Case-Control Studies Chemoprophylaxis Immunology Cytomegalovirus Infections Female business Serostatus Immunosuppressive Agents medicine.drug |
| Popis: | Background Cytomegalovirus (CMV) disease is a serious infection after kidney transplantation. The risk factors and the impact of CMV disease in African-American (AA) kidney transplant patients have not been well characterized. Methods We performed a retrospective analysis on 448 AA patients transplanted between 1996 and 2005. A 3-month universal chemoprophylaxis with ganciclovir or valganciclovir was administered to CMV donor-positive/recipient-negative (D+/R−) patients and to those treated with anti-thymocyte globulin for rejection, but not routinely to those with other D/R serostatus. Results A total of 31 AA patients (7%) developed clinical CMV disease. Compared with other D/R serostatus groups, the D+/R− group had the highest 3-year cumulative incidence of CMV disease (16.9% vs. 6.3% in D+/R+, 4.9% in D−/R+, and 2.4% in D−/R−). The D+/R− group also had the worst 3-year death-censored allograft survival (75% vs. 92% in D+/R+, 94% in D−/R+, and 96% in D−/R−, log-rank P = 0.01). Multivariate analysis found that D+/R− serostatus (odds ratio [OR] 5.4, 95% confidence interval [CI] 0.6–48.2, P = 0.003) and donor age > 60 years (OR 9.1, 95% CI 1.3–65, P = 0.03) were independent risk factors for CMV disease. Conclusion The D+/R− group has the highest incidence of CMV disease and the worst 3-year renal allograft survival despite 3-month universal prophylaxis. Prolonged chemoprophylaxis may be needed to prevent the late development of CMV disease and to improve allograft survival in the high-risk group of AA kidney transplant recipients. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|