Prevention strategies for cytomegalovirus disease and long‐term outcomes in the high‐risk transplant patient (D+/R−): experience from the RESITRA‐REIPI cohort. Issue 3 (8th May 2014)

• Record Type: Journal Article
• Authors: Meije, Y.; Fortún, J.; Len, Ó.; Aguado, J.M.; Moreno, A.; Cisneros, J.M.; Gurguí, M.; Carratalà, J.; Muñoz, P.; Montejo, M.; Blanes, M.; Bou, G.; Pérez, J.L.; Torre‐Cisneros, J.; Ramos, A.; Pahissa, A.; Gavaldà, J.; Spanish Network for Research on Infection in Transplantation (RESITRA) and the Spanish Network for Research on Infectious Diseases (REIPI)
• Is Part Of: Transplant infectious disease. Volume 16:Issue 3(2014)
• Page Start: 387
• Page End: 396
• Publication Date: 2014-05-08
• Subjects: Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.12226
• Languages: English
• ISSNs: 1398-2273

Abstract

<abstract abstract-type="main" id="tid12226-abs-0001"> <title>Abstract</title> <sec id="tid12226-sec-0001" sec-type="section"> <title>Background</title> <p>Cytomegalovirus (CMV)‐negative recipients of a graft from a CMV‐positive donor (D+/R−) are at high risk of CMV disease. Current preventive strategies include universal prophylaxis (UP) and preemptive therapy (PT). However, the best strategy to prevent CMV disease and achieve better long‐term outcomes remains a matter of debate.</p> </sec> <sec id="tid12226-sec-0002" sec-type="section"> <title>Methods</title> <p>We analyzed the incidence of CMV disease and long‐term outcomes including graft dysfunction and patient mortality at 5 years after transplantation with both preventive strategies. High‐risk (D+/R−) kidney and liver transplant recipients from the RESITRA cohort were included.</p> </sec> <sec id="tid12226-sec-0003" sec-type="section"> <title>Results</title> <p>Of 2410 kidney or liver transplant patients, 195 (8.3%) were D+/R−. The final cohort included 58 liver and 102 kidney recipients. UP was given in 92 patients and 68 received PT; 10.9% and 36.8% developed CMV disease, respectively (<italic>P</italic> < 0.01). The independent risk factors for CMV disease were PT strategy (hazard ratio [HR], 3.30; 95% confidence interval [CI], 1.6–6.9), kidney transplantation (HR, 3.8; 95% CI, 1.4–9.9), and cyclosporine immunosuppression (HR, 2.4; 95% CI, 1.2–4.7). PT strategy was also a risk factor for CMV disease in both liver transplantation (HR, 11.0; 95% CI, 1.2–98.7) and kidney transplantation (HR, 2.7; 95% CI, 1.3–6.0), independently. The development of CMV replication during the first 2 years after transplantation was a risk factor for graft dysfunction at 5 years after transplantation (odds ratio, 3.4; 95% CI, 1.3–9.0). Nevertheless, no significant differences were seen in either graft dysfunction or mortality between the 2 strategies.</p> </sec> <sec id="tid12226-sec-0004" sec-type="section"> <title>Conclusions</title> <p>The study supports the benefit of the UP strategy to prevent CMV disease in D+/R− liver or kidney transplant patients. The development of CMV replication during the first 2 years after transplantation was associated with graft dysfunction at 5 years after transplantation.</p> </sec> </abstract>