Cytomegalovirus prevention strategies in seropositive kidney transplant recipients: an insight into current clinical practice
Por:
Fernandez-Ruiz, M, Arias, M, Campistol, JM, Navarro, D, Gomez-Huertas, E, Gomez-Marquez, G, Diaz, JM, Hernandez, D, Bernal-Blanco, G, Cofan, F, Jimeno, L, Franco-Esteve, A, Gonzalez, E, Moreso, FJ, Gomez-Alamillo, C, Mendiluce, A, Luna-Huerta, E, Aguado, JM
Publicada:
1 sep 2015
Resumen:
There is notable heterogeneity in the implementation of cytomegalovirus (CMV) prevention practices among CMV-seropositive (R+) kidney transplant (KT) recipients. In this prospective observational study, we included 387 CMV R+ KT recipients from 25 Spanish centers. Prevention strategies (antiviral prophylaxis or preemptive therapy) were applied according to institutional protocols at each site. The impact on the 12-month incidence of CMV disease was assessed by Cox regression. Asymptomatic CMV infection, acute rejection, graft function, non-CMV infection, graft loss, and all-cause mortality were also analyzed (secondary outcomes). Models were adjusted for a propensity score (PS) analysis for receiving antiviral prophylaxis. Overall, 190 patients (49.1%) received preemptive therapy, 185 (47.8%) antiviral prophylaxis, and 12 (3.1%) no specific intervention. Twelve-month cumulative incidences of CMV disease and asymptomatic infection were 3.6% and 39.3%, respectively. Patients on prophylaxis had lower incidence of CMV disease [PS-adjusted HR (aHR): 0.10; 95% confidence interval (CI): 0.01-0.79] and asymptomatic infection (aHR: 0.46; 95% CI: 0.29-0.72) than those managed preemptively, with no significant differences according to the duration of prophylaxis. All cases of CMV disease in the prophylaxis group occurred after prophylaxis discontinuation. There were no differences in any of the secondary outcomes. In conclusion, antiviral prophylaxis was associated with a lower occurrence of CMV disease in CMV R+ KT recipients, although such benefit should be balanced with the risk of late-onset disease.
Filiaciones:
Fernandez-Ruiz, M:
Hosp Univ 12 Octubre, Infect Dis Unit, Inst Invest Hosp 12 Octubre i 12, Madrid 28041, Spain
Arias, M:
Hosp Univ Marques de Valdecilla, Inst Formac & Invest Marques de Valdecilla IFIMAV, Dept Nephrol, Santander, Spain
Campistol, JM:
Hosp Clin Barcelona, Inst Invest Biomed August Pi & Sunyer IDIBAPS, Dept Nephrol, Barcelona, Spain
Navarro, D:
Univ Valencia, Inst Invest Sanitaria INCLIVA, Hosp Clin Univ, Dept Microbiol, Valencia, Spain
Gomez-Huertas, E:
Univ Oviedo, Hosp Cent Asturias, Dept Nephrol, E-33080 Oviedo, Spain
Gomez-Marquez, G:
Hosp Univ Son Espases, Dept Nephrol, Palma De Mallorca, Spain
Diaz, JM:
Fundacio Puigvert, Dept Nephrol, Barcelona, Spain
Hernandez, D:
Hosp Univ Carlos Haya, Dept Nephrol, Malaga, Spain
Bernal-Blanco, G:
Hosp Univ Virgen del Rocio, Inst Biomed Sevilla IBIS, Dept Nephrol, Seville, Spain
Cofan, F:
Hosp Clin Barcelona, Inst Invest Biomed August Pi & Sunyer IDIBAPS, Dept Nephrol, Barcelona, Spain
Jimeno, L:
Hosp Univ Virgen de la Arrixaca, Dept Nephrol, Murcia, Spain
Franco-Esteve, A:
Hosp Gen Alicante, Nephrol Unit, Alicante, Spain
Gonzalez, E:
Hosp Univ 12 Octubre, Dept Nephrol, Inst Invest Hosp 12 Octubre i 12, Madrid 28041, Spain
Moreso, FJ:
Hosp Univ Vall dHebron, Dept Nephrol, Barcelona, Spain
Gomez-Alamillo, C:
Hosp Univ Marques de Valdecilla, Inst Formac & Invest Marques de Valdecilla IFIMAV, Dept Nephrol, Santander, Spain
Mendiluce, A:
Hosp Clin Univ, Dept Nephrol, Valladolid, Spain.
Luna-Huerta, E:
Hosp Univ Infanta Cristina, Dept Nephrol, Badajoz, Spain
Aguado, JM:
Hosp Univ 12 Octubre, Infect Dis Unit, Inst Invest Hosp 12 Octubre i 12, Madrid 28041, Spain
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