Comparing cytomegalovirus prophylaxis in renal transplantation: single center experience

Varga, Marina; Remport, Ádám; Hı́dvégi, M.; Péter, Antal; Kopper, László; Telkes, Gábor; Fazakas, János; Gerlei, Zsuzsanna; Sárváry, Enikő; B, Sulyok; Járay, J.

doi:10.1111/j.1399-3062.2005.00094.x

Cited by 17 publications

(10 citation statements)

References 17 publications

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“…A comparison of the efficacy of acyclovir, ganciclovir and anti-CMV hyperimmune globulin showed improved graft survival of approximately the same degree. Varga et al (14) found that CMV hyperimmune globulin and/or oral ganciclovir significantly reduced CMV infection with ganciclovir being more effective than CMV hyperimmune gammaglobulin monotherapy and more cost effective than combined therapy. Some evidence suggests that the benefits of anti-viral CMV prophylaxis may be limited to the duration of prophylaxis, as there are studies showing late onset CMV infection after cessation of prophylactic therapy (18).…”

Section: Discussionmentioning

confidence: 99%

Acute rejection episodes in pediatric renal transplant recipients with cytomegalovirus infection

Kranz

Vester

Wingen

et al. 2007

Pediatric Transplantation

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CMV infection is the most important opportunistic virus infection after renal transplantation leading to increased patient mortality, graft loss, risk for acute rejection episodes and impaired renal function. The potential impact of prophylactic anti-viral therapy on long-term graft outcome is relevant. The aim of this study was to evaluate the incidence of CMV infection, its risk factors and long-term outcome in children after renal transplantation. 103 children (mean age 10.6 +/- 5.3, range 1.6-22.0 yr) were monitored weekly for pp65 for the first 6-8 wk after renal transplantation, followed by a monthly monitoring for the first year. CMV infection occurred in 23/103 children (21.1%) with 10 patients (9.7%) developing CMV disease characterized by positive pp65 in the presence of organ involvement. The CMV R-/D+ and R+/D+ serostatus was significantly associated with an increased risk of CMV infection (p < 0.0001 and p = 0.009). 14/28 R-/D+ patients developed CMV infection despite prophylactic treatment with CMV hyperimmune globulin. The incidence of acute rejection episodes after or during CMV infection was significantly increased (p = 0.003) and the D+ serostatus was significantly associated with acute rejection episodes within the first year after transplantation (p = 0.006). In summary the overall incidence of CMV infection in this single center experience is 21.1%. The D+ serostatus represents a serious risk factor for both CMV infection and acute rejection episodes. In future the potential impact of different modalities of prophylactic anti-viral therapy on the prevention of acute rejection should be considered.

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Section: Discussionmentioning

confidence: 99%

Acute rejection episodes in pediatric renal transplant recipients with cytomegalovirus infection

Kranz

Vester

Wingen

et al. 2007

Pediatric Transplantation

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“…In fact, several studies have reported the successful prevention of CMV disease in high-risk transplant recipients using passive immunization [26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Association of the Outcome of Renal Transplantation with Antibody Response to Cytomegalovirus Strain--Specific Glycoprotein H Epitopes

Ishibashi

Tokumoto

Tanabe

et al. 2007

Clinical Infectious Diseases

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Background. Cytomegalovirus (CMV) is the most important pathogen affecting the outcome of renal transplantation. The combination of CMV-seronegative transplant recipients with CMV-seropositive transplant donors places recipients at the highest risk of CMV disease. In cases of congenital CMV infection, existing immunity only partially protected mothers from reinfection with a different genotypic strain. The effect of differences in infected CMV strains between CMV-seropositive transplant donors and CMV seropositive transplant recipients on the outcome of transplantation remains unclear.Methods. In this prospective multicenter study, the presence of antibodies against strain-specific glycoprotein H epitopes in 84 CMV-seropositive transplant donor/CMV-seropositive transplant recipient renal transplantation cases were determined, and their relationships to acute transplant rejection, CMV infection, degree of antigenemia, and CMV disease were evaluated.Results. Among the 84 donor/recipient pairs, 45 and 32 had matched and mismatched strain-specific glycoprotein H antibodies, respectively. Acute transplant rejection in the mismatched group was more frequent than it was in the matched group (63% vs. 22%;). CMV disease was also more frequently observed in the P p .005 mismatched group (28% vs. 9%;). The mismatched group had a higher level of antigenemia ( P p .026 P p ). .019Conclusions. Our results illustrate more adverse events in the cases with a CMV-seropositive transplant donor and a CMV-seropositive transplant recipient in which the glycoprotein H antibodies are mismatched, suggesting that reinfection with a different CMV strain results in more complications.

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“…CMV intravenous immunoglobulin (CMV-IVIG) decreases the incidence of CMV disease in DϩRϪ kidney transplant recipients (12) and has been approved for prevention of CMV disease in SOT and kidney transplant recipients by U.S. and Canadian regulatory agencies, respectively (13,14). However, prophylactic use of CMV-IVIG is uncommon (15,16), likely due to the availability of oral antivirals and cost (17)(18)(19).…”

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confidence: 99%

Phase 2 Randomized, Double-Blind, Placebo-Controlled Trial of RG7667, a Combination Monoclonal Antibody, for Prevention of Cytomegalovirus Infection in High-Risk Kidney Transplant Recipients

Ishida

Patel²,

Mehta

et al. 2017

Antimicrob Agents Chemother

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Cytomegalovirus (CMV) infection is a significant complication after kidney transplantation. We examined the ability of RG7667, a combination of two monoclonal antibodies, to prevent CMV infection in high-risk kidney transplant recipients in a randomized, double-blind, placebo-controlled trial. CMV-seronegative recipients of a kidney transplant from a CMV-seropositive donor (DϩRϪ) were randomized to receive RG7667 (n ϭ 60) or placebo (n ϭ 60) at the time of transplant and 1, 4, and 8 weeks posttransplant. Patients were monitored for CMV viremia every 1 to 2 weeks posttransplant for 24 weeks. Patients who had seroconverted (DϩRϩ) or withdrawn before dosing were excluded from the analysis (n ϭ 4). CMV viremia occurred in 27 of 59 (45.8%) patients receiving RG7667 and 35 of 57 (61.4%) patients receiving placebo (stratum-adjusted difference, 15.3%; P ϭ 0.100) within 12 weeks posttransplant and in 30 of 59 (50.8%) patients receiving RG7667 and 40 of 57 (70.2%) patients receiving placebo (stratum-adjusted difference, 19.3%; P ϭ 0.040) within 24 weeks posttransplant. Median time to CMV viremia was 139 days in patients receiving RG7667 compared to 46 days in patients receiving placebo (hazard ratio, 0.53; P ϭ 0.009). CMV disease was less common in the RG7667 than placebo group (3.4% versus 15.8%; P ϭ 0.030). Adverse events were generally balanced between treatment groups. In high-risk kidney transplant recipients, RG7667 was well tolerated, numerically reduced the incidence of CMV infection within 12 and 24 weeks posttransplant, delayed time to CMV viremia, and was associated with less CMV disease than the placebo. (This study has been registered at ClinicalTrials.gov under registration no. NCT01753167.)

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Comparing cytomegalovirus prophylaxis in renal transplantation: single center experience

Abstract: Prophylaxis with hyperimmune gammaglobulin and/or oral ganciclovir significantly reduces CMV infection and disease. Prophylaxis with ganciclovir was significantly more effective than hyperimmune gammaglobulin monoprophylaxis, and more cost effective than combined prophylaxis.

Cited by 17 publications

References 17 publications

Acute rejection episodes in pediatric renal transplant recipients with cytomegalovirus infection

Acute rejection episodes in pediatric renal transplant recipients with cytomegalovirus infection

Association of the Outcome of Renal Transplantation with Antibody Response to Cytomegalovirus Strain--Specific Glycoprotein H Epitopes

Phase 2 Randomized, Double-Blind, Placebo-Controlled Trial of RG7667, a Combination Monoclonal Antibody, for Prevention of Cytomegalovirus Infection in High-Risk Kidney Transplant Recipients

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