Age matters: older age as a risk factor for CMV reactivation in the CMV serostatus–positive kidney transplant recipient

Hemmersbach‐Miller, Marion; Alexander, Barbara D.; Pieper, Carl F.; Schmader, Kenneth E.

doi:10.1007/s10096-019-03744-3

Cited by 20 publications

(21 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The opportune use of antivirals controls viral replication of CMV and reduces the risk of recurrences after transplant; however, despite their use, viral replication and recurrences are described in 30%-50% (Hodson et al 2013;Ricart et al 2005;Natori et al 2017;Gardiner et al 2019;Hemmersbach-Miller et al 2020). Universal prophylaxis, preventive therapy, or a combined strategy that includes vigilance after prophylaxis, are the primary approaches for prevention (Kotton et al 2018).…”

Section: Introductionmentioning

confidence: 99%

Cytomegalovirus in renal transplant recipients from living donors with and without valganciclovir prophylaxis and with immunosuppression based on anti-thymocyte globulin or basiliximab

Andrade‐Sierra

Heredia-Pimentel

Rojas‐Campos

et al. 2021

International Journal of Infectious Diseases

View full text Add to dashboard Cite

Background:In our population, anti-thymocyte globulin (ATG) of 1 mg/Kg/day for 4 days is used; which permits not using valgancyclovir (VGC) prophylaxis in some renal transplant recipients (RTR) with moderate risk (R+), to reduce costs. This study aimed to determine the incidence and risk of developing cytomegalovirus (CMV), with or without prophylaxis, when exposed to low doses of ATG or basiliximab (BSL). Patients and methods: A retrospective cohort included 265 RTR with follow-up of 12 months. Prophylaxis was used in R-/D+ and some R+. Tacrolimus (TAC), mycophenolate mofetil, and prednisone were used in all patients. Logistic regression analysis was performed to estimate the risk of CMV in RTR with or without VGC. Results: Cytomegalovirus was documented in 46 (17.3%) patients: 20 (43.5%) with CMV infection, and 26 (56.5%) with CMV disease. Anti-thymocyte globulin was used in 39 patients (85%): 32 R+, six D+/R-, and one D-/R-. ATG was used in 90% (27 of 30) of patients with CMV and without prophylaxis. The multivariate analysis showed an association of risk for CMV with the absence of prophylaxis (RR 2.29; 95% CI 1.08-4.86), ATG use (RR 3.7; 95% CI 1.50-9.13), TAC toxicity (RR 3.77; 95% CI 1.41-10.13), and lymphocytes at the sixth post-transplant month (RR 1.77; 95% CI 1.0-3.16). Conclusions: Low doses of ATG favored the development of CMV and a lower survival free of CMV compared with BSL. In scenarios where resources for employing VGC are limited, BSL could be an acceptable strategy.

show abstract

Section: Introductionmentioning

confidence: 99%

Cytomegalovirus in renal transplant recipients from living donors with and without valganciclovir prophylaxis and with immunosuppression based on anti-thymocyte globulin or basiliximab

Andrade‐Sierra

Heredia-Pimentel

Rojas‐Campos

et al. 2021

International Journal of Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…Older age (>65 years) has been indicated as an important risk factor of CMV reactivation in kidney (HR = 2.43) and allogeneic hematopoietic stem cell transplant (HSCT; aged >50 years old; HR 1.40; 95% CI, 1.24–1.58) recipients [ 38 , 39 , 40 ]. In HSCT patients, CMV reactivation increases with T cell depletion and long-course steroid treatment [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Real-world evidence of cytomegalovirus reactivation in non-Hodgkin lymphomas treated with bendamustine-containing regimens

et al. 2021

View full text Add to dashboard Cite

Cytomegalovirus (CMV) reactivation during chemotherapy or after organ or hematopoietic stem cell transplantation is a major cause of morbidity and mortality, and the risk of reactivation increases with patients’ age. Bendamustine, an alkylating agent currently used for treatment of indolent and aggressive non-Hodgkin lymphomas, can augment the risk of secondary infections including CMV reactivation. In this real-world study, we described an increased incidence of CMV reactivation in older adults (age >60 years old) with newly diagnosed and relapsed/refractory indolent and aggressive diseases treated with bendamustine-containing regimens. In particular, patients who received bendamustine plus rituximab and dexamethasone were at higher risk of CMV reactivation, especially when administered as first-line therapy and after the third course of bendamustine. In addition, patients with CMV reactivation showed a significant depression of circulating CD4+ T cell count and anti-CMV IgG levels during active infection, suggesting an impairment of immune system functions which are not able to properly face viral reactivation. Therefore, a close and early monitoring of clinical and laboratory findings might improve clinical management and outcome of non-Hodgkin lymphoma patients by preventing the development of CMV disease in a subgroup of subjects treated with bendamustine more susceptible to viral reactivation.

show abstract

“…In general, patients who received Protocol 1 were at higher CMV risk, with a greater proportion receiving thymoglobulin, but the incidence of CMV was not increased compared to Protocol 2. The increased number of ABO incompatible transplants, use of ECD and older recipients in Protocol 2 -known risk factors for CMV infections [16][17][18] -could have blunted the effects of the differences in prophylaxis regimen.…”

Section: Discussionmentioning

confidence: 99%

“…Post-prophylaxis CMV reactivation is not a new finding. 1,14,[16][17][18]23 Its specific pathophysiology is likely related to the complex interaction between CMV virus and the host, compounded by the use of immunosuppressants. Some experts believe that the lack of reconstitution of CMVspecific cellular immunity in transplant recipients could explain this phenomenon.…”

Section: Discussionmentioning

confidence: 99%

A single-centre observational study comparing the impact of different cytomegalovirus prophylaxis strategies on cytomegalovirus infections in kidney transplant recipients

Tan

Chung

et al. 2020

Proceedings of Singapore Healthcare

View full text Add to dashboard Cite

Background/objective: Prevention of cytomegalovirus (CMV) infection is an important component of post kidney transplant care. We aimed to evaluate the impact of two different CMV prophylaxis protocols on the epidemiology and outcomes of CMV infections at our centre. Methods: This is a single-centre retrospective before/after observational study. Kidney transplant recipients who received Protocol 1, a valacyclovir- or valganciclovir-based regimen prescribed for one to three months based on the CMV risk status between 2004 and 2008, were compared to those who received Protocol 2, a valganciclovir-based regimen prescribed for three months and six months for those at moderate and high risk, respectively, between 2010 and 2014. The impact of different prophylaxis regimens on the incidence of CMV infections, disease, recurrent infections and onset of CMV infection at 24 months were reviewed. Results: There were 192 patients included; 106 patients received Protocol 1, 86 received Protocol 2. At 24 months, the incidence of CMV infection was 53.8% and 55.8% in Protocols 1 and 2, respectively ( p=0.884). The incidence rates of CMV disease and recurrent CMV infections were higher in Protocol 1, but this was not statistically significant. The median time to first CMV infection was significantly shorter in patients who received Protocol 1: 132 days (interquartile range (IQR) 125–139 days) versus 185 days (IQR 178–192 days), p=0.001. Both prophylaxis protocols were well tolerated. Conclusion: The incidence of CMV infection was similar in both protocols. Where valganciclovir is not available, valacyclovir may be considered over no prophylaxis. Post-prophylaxis CMV infections are not uncommon, and vigilance for it should be advocated.

show abstract

Age matters: older age as a risk factor for CMV reactivation in the CMV serostatus–positive kidney transplant recipient

Cited by 20 publications

References 41 publications

Cytomegalovirus in renal transplant recipients from living donors with and without valganciclovir prophylaxis and with immunosuppression based on anti-thymocyte globulin or basiliximab

Cytomegalovirus in renal transplant recipients from living donors with and without valganciclovir prophylaxis and with immunosuppression based on anti-thymocyte globulin or basiliximab

Real-world evidence of cytomegalovirus reactivation in non-Hodgkin lymphomas treated with bendamustine-containing regimens

A single-centre observational study comparing the impact of different cytomegalovirus prophylaxis strategies on cytomegalovirus infections in kidney transplant recipients

Contact Info

Product

Resources

About