Targeted preemptive therapy according to perceived risk of CMV infection after kidney transplantation

Pinto, Cahue Henrique; Tedesco‐Silva, Hélio; Felipe, Cláudia Rosso; Ferreira, Alexandra; Cristelli, Marina Pontello; Viana, Laila Almeida; Aguiar, Wilson; Medina-Pestana, J.O.

doi:10.1016/j.bjid.2016.08.007

Cited by 14 publications

(17 citation statements)

References 38 publications

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“…Early rejection and lower renal function in the first month were independent of risk factors associated with CMV infection after tAR. This result was confirmed based on a previous study which showed 48% of CMV infection/disease after treatment of acute rejection in another cohort of 144 kidney transplant recipients . Another study showed a relationship between tissue invasive CMV disease and acute rejection (OR 2.81; 95% CI, 1.08‐7.29, P = 0.03) within 6 months of kidney transplantation …”

Section: Discussionsupporting

confidence: 72%

Incidence and risk factors associated with cytomegalovirus infection after the treatment of acute rejection during the first year in kidney transplant recipients receiving preemptive therapy

Felipe

Ferreira

Paula

et al. 2019

Transplant Infectious Dis

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There have been progressive and considerable improvements in the early management of kidney transplant recipients, including HLA matching, induction, maintenance immunosuppressive therapy, and infection prophylaxis, leading to lower incidences of acute rejection and infection, primarily, cytomegalovirus (CMV) infection. 1 The availability of a highly effective oral drug, valganciclovir, is perhaps the primary reason for the growing shift from preemptive therapy to universal CMV prophylaxis. 2 Yet, drug-related toxicities, late CMV infection after discontinuation of prophylaxis, and costs are critical concerns. 3 The intricate relationship between CMV infection and acute rejection, 4,5 as well as their negative influence on renal function and graft survival 6 are well known. A recent retrospective cohort study showed no difference in the incidence of CMV Abstract Introduction: The complex interaction between cytomegalovirus (CMV) infection and acute rejection after kidney transplantation is well recognized.Methods: This single center retrospective cohort analysis investigated the incidence and risk factors associated with CMV infection after treatment for acute rejection (tAR) in kidney transplant recipients receiving only CMV preemptive therapy. Of the 938 kidney transplants performed between 04/30/2014 and 04/30/2015 we identified 87 (9.3%) that were treated for acute rejection within the first year.Results: Most patients (64%) received rATG induction therapy followed by tacrolimus in combination with azathioprine (67%) or mycophenolate (33%) and corticosteroids.The incidence of CMV infection/disease after tAR was 47%, of which 73% occurred within 30 days. Using multivariable logistic regression analysis, eGFR at 1 month (OR = 0.98; 95% CI, 0.97-0.99; P = 0.007) and timing of tAR (OR = 0.98; 95% CI, 0.96-0.99; P = 0.021) were independently associated with CMV infection/disease after tAR. Conclusion:In this cohort of kidney transplant recipients receiving tacrolimus-based immunosuppressive and preemptive CMV therapy, almost 50% developed CMV infection/disease after tARin the first year of transplantation. Early rejection and poor initial renal function were risk factors associated with CMV infection or disease. K E Y W O R D Sacute rejection, cytomegalovirus, kidney transplant

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Section: Discussionsupporting

confidence: 72%

Incidence and risk factors associated with cytomegalovirus infection after the treatment of acute rejection during the first year in kidney transplant recipients receiving preemptive therapy

Felipe

Ferreira

Paula

et al. 2019

Transplant Infectious Dis

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“…In this group of patients, the use of induction therapy with basiliximab [6,7] or substitution of azathioprine by mycophenolate [8] may not provide substantial efficacy, safety and cost advantage. In two independent cohorts of patients receiving TAC, AZA, and PRED without induction therapy, we recently showed that the incidence of AR was 32% and of CMV infection was 30% [9], and that the incidence of CMV infection after treatment of AR was 47% [10].…”

Section: Introductionmentioning

confidence: 99%

Decreased incidence of acute rejection without increased incidence of cytomegalovirus (CMV) infection in kidney transplant recipients receiving rabbit anti‐thymocyte globulin without CMV prophylaxis – a cohort single‐center study

et al. 2020

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Summary Induction therapy with rabbit anti‐thymocyte globulin (rATG) in low‐risk kidney transplant recipients (KTR) remains controversial, given the associated increased risk of cytomegalovirus (CMV) infection. This natural experiment compared 12‐month clinical outcomes in low‐risk KTR without CMV prophylaxis (January/3/13–September/16/15) receiving no induction or a single 3 mg/kg dose of rATG. We used logistic regression to characterize delayed graft function (DGF), negative binomial to characterize length of hospital stay (LOS), and Cox regression to characterize acute rejection (AR), CMV infection, graft loss, death, and hospital readmissions. Recipients receiving 3 mg/kg rATG had an 81% lower risk of AR (aHR 0.140.190.25, P < 0.001) but no increased rate of hospital readmissions because of infections (0.680.911.21, P = 0.5). There was no association between 3 mg/kg rATG and CMV infection/disease (aHR 0.861.101.40, P = 0.5), even when the analysis was stratified according to recipient CMV serostatus positive (aHR 0.941.251.65, P = 0.1) and negative (aHR 0.280.571.16, P = 0.1). There was no association between 3 mg/kg rATG and mortality (aHR 0.511.253.08, P = 0.6), and graft loss (aHR 0.340.731.55, P = 0.4). Among low‐risk KTR receiving no CMV pharmacological prophylaxis, 3 mg/kg rATG induction was associated with a significant reduction in the incidence of AR without an increased risk of CMV infection, regardless of recipient pretransplant CMV serostatus.

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“…With a preemptive strategy, CMV disease still occurred in 13% of a Brazilian R+ cohort given ATG induction therapy . At our center, when preemptive therapy was tried in the D+/R+ population given ATG induction therapy, 83% of the patients developed CMV viremia and started preemptive treatment (in part, because there was no established threshold value for initiating treatment).…”

Section: Introductionmentioning

confidence: 99%

Cytomegalovirus prophylaxis in seropositive renal transplant recipients receiving thymoglobulin induction therapy: Outcome and risk factors for late CMV disease

Reusing

Feitosa

Agena

et al. 2018

Transplant Infectious Dis

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Targeted preemptive therapy according to perceived risk of CMV infection after kidney transplantation

Cited by 14 publications

References 38 publications

Incidence and risk factors associated with cytomegalovirus infection after the treatment of acute rejection during the first year in kidney transplant recipients receiving preemptive therapy

Incidence and risk factors associated with cytomegalovirus infection after the treatment of acute rejection during the first year in kidney transplant recipients receiving preemptive therapy

Decreased incidence of acute rejection without increased incidence of cytomegalovirus (CMV) infection in kidney transplant recipients receiving rabbit anti‐thymocyte globulin without CMV prophylaxis – a cohort single‐center study

Cytomegalovirus prophylaxis in seropositive renal transplant recipients receiving thymoglobulin induction therapy: Outcome and risk factors for late CMV disease

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