Prevalence and Clinical Impact of Cytomegalovirus Infection and Disease in Renal Transplantation: Ten Years of Experience in a Single Center
| Autor: | G. Imvrios, I. Gerogiannis, Dimitrios Giakoustidis, D. Gakis, Alexandros Giakoustidis, P. Christoforou, Ioannis Fouzas, N. Ouzounidis, A. Sklavos, G. Myserlis, A Antoniadis, F. Solonaki, T. Deligiannidis, A. Tsitlakidis, K. Koubanagiti, A. Papagiannis, V. Papanikolaou |
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| Rok vydání: | 2012 |
| Předmět: |
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Time Factors medicine.medical_treatment Cytomegalovirus Gastroenterology Blood Urea Nitrogen chemistry.chemical_compound Living Donors Prevalence Valganciclovir Blood urea nitrogen education.field_of_study Greece Incidence Graft Survival virus diseases Immunosuppression Middle Aged Viral Load Treatment Outcome Creatinine Cytomegalovirus Infections Drug Therapy Combination Female Viral load Immunosuppressive Agents medicine.drug Adult medicine.medical_specialty Population Antiviral Agents Drug Administration Schedule Pharmacotherapy Internal medicine medicine Humans education Ganciclovir Aged Retrospective Studies Transplantation business.industry Kidney Transplantation Surgery chemistry Multivariate Analysis Linear Models business Biomarkers |
| Zdroj: | Transplantation Proceedings. 44:2715-2717 |
| ISSN: | 0041-1345 |
| Popis: | Introduction Renal transplantation is regarded as the optimal treatment for patients with end-stage renal disease. Despite significant improvements in surgical techniques and immunosuppressive therapy, long-term graft survival has not markedly increased over the years, due in part to the occurrence of cytomegalovirus (CMV) infection. Patients and Methods Between January 2001 and September 2011, we performed 592 kidney transplantations (214 living and 378 cadaveric donors). All patients received induction therapy with interleukin (IL)-2 monoclonal antibodies or antithymoglobulin (ATG) combined with calcineurin inhibitors, mycophenolate mofetil, or mTOR antagonists and steroids. All CMV-seronegative patients and all subjects receiving ATG induction were prescribed prophylactic therapy with ganciclovir—intravenous (IV) for 15 days 2.5 mg/kg BW bid and thereafter oral valgancyclovir once a day. CMV infection was diagnosed using a CMV-PVR of ≥600 copies. We analyzed the time to manifestations of CMV infection, or positive CMV-PCR, patient and graft survival, serum creatinine (Cr), and blood urea nitrogen (BUN) values before and after CMV infection, as well as type of immunosuppression therapy. Results The overall incidences of CMV infection and CMV disease were 76/592 (12.8%) and 23/592 (3.9%), respectively. The mean ± standard deviation (SD) times to positive CMV-PCR and CMV disease were 16.66 ± 23.38 months and 106 ± 61.2 (range, 28–215) days, respectively. Mortality was 1% (6/592) among our whole population, 7.9% (6/76) for CMV-infected, and 26% (6/23) in the CMV disease cohort. Cr and BUN showed no significant differences among the groups. Conclusions CMV infection and CMV disease comprise significant clinical problems, increasing morbidity and mortality. The use of prophylactic anti-CMV treatment is of paramount importance. |
| Databáze: | OpenAIRE |
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