Current characteristics and outcomes of Cytomegalovirus Reactivation in kidney transplant seropositive recipients in the era of prophylaxis treatment. Lesson from single Moroccan center experience

Abstract

Despite the use of antiviral prophylaxis, the active cytomegalovirus (CMV) replication is still occurred in the seropositive kidney recipients. The aim of this study was to assess the incidence of CMV reactivation and potential risk factors associated with CMV disease. Data of sixty kidney transplant recipients who had received CMV prophylaxis were obtained between 2013 and 2017. Quantitative nucleic acid amplification testing for CMV viraemia was assessed using Abbott RealTime Polymerase Chain Reaction (PCR). Among the seropositive recipients, cumulative incidence for reactivation was 63%. In patients with quantitative viraemia, the time of active replication was significantly lower compared to those with detectable viraemia (141.5, SD:96.9 vs 294.1, SD: 112.6 days, P inferior to 0.001). During prophylactic treatment, 46.7% of patients with quantifiable viraemia had experienced active replication and none among patients with detectable viraemia (P= 0.017). Importantly, symptomatic reactivation was significantly observed in the younger patients with higher peak viraemia compared to those with symptoms free (28.8, SD:5.12 vs. 38.1, SD: 12.34 years, P= 0.007) and 3.8, SD: 1.59 vs. 2.4, SD: 0. 79 log10IU/ml, P = 0.003, respectively). Furthermore, the median duration of viraemia (21.2, vs. 13.4 days, P= 0.028) and period of CMV therapy (24.3 vs 12.3 days, P inferior to 0.001) were significantly longer for this group. In addition, intercurrent infections (75% vs. 23%, P = 0.028 ) and acute rejection (50 % vs 0%, P = 0.003) were significantly more frequent in symptomatic reactivation group. In addition, peak viral load was a potential risk factor for development of symptomatic reactivation with odds ratio 3.39, 95%CI=1.21-9.53, P = 0.02). In conclusion, CMV reactivation remains serious problem for seropositive recipients who were expected to be on antiviral prophylaxis. Patients with high level of viraemia may be at an increased risk of progression to CMV disease and adverse outcomes.

Efficacy and safety of conventional antiviral agents in preventive strategies for cytomegalovirus infection after kidney transplantation: a systematic review and network meta‐analysis

“…Likewise, GC is available in only intravenous form [ 19 , 20 , 21 ]. For these reasons, VAC and AC, have been studied to use as universal prophylaxis, as they were still prescribed in developing countries for prophylaxis of CMV infection/disease [ 22 , 23 ] with less bone marrow suppression than GC [ 24 ]. Although previous systematic reviews (SR) and meta‐analyses (MA) have assessed the efficacy of some antiviral agents, and pooled all solid organ transplants without focusing specifically on KT [ 25 , 26 , 27 , 28 ].…”