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

Reusing, José Otto; Feitosa, Emanoela B.; Agena, Fabiana; Pierrotti, Lı́gia Camera; Azevedo, Luiz Sergio; Kotton, Camille Nelson; David‐Neto, Elias

doi:10.1111/tid.12929

Cited by 21 publications

(27 citation statements)

References 47 publications

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“…The incidence of HCMV‐disease in patients who use prophylactic or preemptive strategies declines when compared with non‐receiving renal transplant recipients . In this study, 7.3% of allograft recipients developed HCMV‐disease.…”

Section: Discussionmentioning

confidence: 61%

Impact assessment and investigation of factors associated with herpesviruses viremia in the first year of renal transplantation

Savassi‐Ribas

Almeida

Baez

et al. 2019

Journal of Medical Virology

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The increased risk for opportunistic infections after a renal transplant requires monitoring of viral infections to avoid future complications. Our goal was to investigate the impact and factors associated with Epstein-Barr virus (EBV), human cytomegalovirus (HCMV) and human herpesvirus type 6 (HHV-6) viremia in renal transplant recipients. Whole blood samples were collected monthly from 82 patients during the first semester and then quarterly up to 1 year after transplantation. EBV, HCMV, and HHV-6 were detected and quantified by TaqMan real-time polymerase chain reaction. The results showed that EBV and HCMV viremia were detected in 32 patients (39% each), while HHV-6 viremia in only 3 patients (3.7%). EBV was significantly associated with age (P = .050), thymoglobuline induction (P = .019), mTOR inhibitor-based therapy (P = .003), and female gender (P = .044). HCMV was significantly associated with basiliximab induction (P = .015), mycophenolate mofetil (MMF)-based therapy (P = .003) and allograft acute rejection (P = .033). Moreover, HCMV-disease was correlated with MMF-based therapy (P = .021) and female gender (P = .003). In conclusion, EBV and HCMV viremia were associated with different immunosuppressive induction and maintenance strategies. Additionally, higher HCMV viremia (> 10 4 copies/mL) was related to acute allograft rejection. K E Y W O R D SEpstein-Barr virus, human cytomegalovirus, human herpesvirus type 6, transplant

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Section: Discussionmentioning

confidence: 61%

Impact assessment and investigation of factors associated with herpesviruses viremia in the first year of renal transplantation

Savassi‐Ribas

Almeida

Baez

et al. 2019

Journal of Medical Virology

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“…Indeed, we observed a low number of opportunistic infections in all types of SOT recipients frequently occurring at later timepoints following transplantation, once prophylaxis is discontinued. Better defining populations at risk for these opportunistic infections will be crucial to further improve the present prophylactic strategies, mostly designed for early infections [ 12 , 19–26 ]. Aspergillus fumigatus , responsible for 1.4% of all infections, is a serious concern, particularly in liver transplant recipients, because of the associated high mortality [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Burden and Timeline of Infectious Diseases in the First Year After Solid Organ Transplantation in the Swiss Transplant Cohort Study

Delden

Stampf

Hirsch

et al. 2020

Clinical Infectious Diseases

146

144

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Background The burden and timeline of posttransplant infections are not comprehensively documented in the current era of immunosuppression and prophylaxis. Methods In this prospective study nested within the Swiss Transplant Cohort Study (STCS), all clinically relevant infections were identified by transplant–infectious diseases physicians in persons receiving solid organ transplant (SOT) between May 2008 and December 2014 with ≥12 months of follow-up. Results Among 3541 SOT recipients, 2761 (1612 kidney, 577 liver, 286 lung, 213 heart, and 73 kidney-pancreas) had ≥12 months of follow-up; 1520 patients (55%) suffered 3520 infections during the first year posttransplantation. Burden and timelines of clinically relevant infections differed between transplantations. Bacteria were responsible for 2202 infections (63%) prevailing throughout the year, with a predominance of Enterobacteriaceae (54%) as urinary pathogens in heart, lung, and kidney transplant recipients, and as digestive tract pathogens in liver transplant recipients. Enterococcus spp (20%) occurred as urinary tract pathogens in kidney transplant recipients and as digestive tract pathogens in liver transplant recipients, and Pseudomonas aeruginosa (9%) in lung transplant recipients. Among 1039 viral infections, herpesviruses predominated (51%) in kidney, liver, and heart transplant recipients. Among 263 fungal infections, Candida spp (60%) prevailed as digestive tract pathogens in liver transplant recipients. Opportunistic pathogens, including Aspergillus fumigatus (1.4%) and cytomegalovirus (6%), were rare, scattering over 12 months across all SOT recipients. Conclusions In the current era of immunosuppression and prophylaxis, SOT recipients experience a high burden of infections throughout the first year posttransplantation, with rare opportunistic pathogens and a predominance of bacteria.

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“…This practice is supported by the previously identified risk from receiving this lymphocyte-depleting agent in CMV-seropositive KT recipients [3]. Reusing et al demonstrated some benefit of anti-CMV prophylaxis in CMV-seropositive KT recipients who received ATG in a retrospective study [14]. More recently, Chiasakul and colleagues implemented targeted prophylaxis in those receiving a standard dose of ATG among high-risk patients such as those who underwent ABO incompatible KT with a favorable outcome [4].…”

Section: Discussionmentioning

confidence: 89%

A Nationwide Survey of Cytomegalovirus Prevention Strategies in Kidney Transplant Recipients in a Resource-Limited Setting

Bruminhent

Bushyakanist

Kantachuvesiri

et al. 2019

Open Forum Infectious Diseases

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Objective Strategies to prevent cytomegalovirus (CMV) infection in resource-limited settings have been under-explored. We investigated CMV prevention strategies utilized among transplant centers in Thailand. Method A questionnaire on CMV prevention strategies for kidney transplant (KT) recipients was developed using a web-based electronic survey website (www.surveymonkey.com). The survey was delivered to 31 transplant centers in Thailand. One infectious disease physician (ID) and 1 nephrologist (NP) from each center were included. Results There were 43 respondents from 26 of the 31 transplant centers (84%), including 26 (60%) IDs and 17 (40%) NPs. Forty-one 95% (41/43) physicians agreed on the necessity of CMV prevention. Of these, 77% (33/43) physicians implemented prevention strategies for their patients. Interventions included preemptive approaches (48%), prophylaxis (45%), hybrid approaches; surveillance after prophylaxis (3%), and CMV-specific immunity-guided approaches (3%). For CMV-seropositive KT recipients, use of preemptive approaches (84%) exceeded prophylaxis (12%). However, 81% of the former preferred targeted prophylaxis in patients receiving antithymocyte globulin therapy. Sixty-five percent and 93% of physicians started preemptive therapy when plasma CMV DNA loads reached 2000 and 3000 copies/mL (1820 and 2730 IU/mL), respectively. A significantly greater percentage of NPs initiated preemptive therapy at a plasma CMV DNA load of 1820 IU/mL compared with IDs (88% vs 50%; P = .02). The most common barrier to prevention strategy implementation was financial inaccessibility of oral valganciclovir (67%) and quantitative CMV DNA testing (12%). Conclusions Most physicians agreed on a need for preemptive approaches, although prophylaxis was targeted in those receiving intense immunosuppression. The financial implication is the main barrier for CMV prevention in Thailand.

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

Abstract: These data indicate that antiviral prophylaxis adequately prevented CMV in seropositive recipients given ATG, but late disease still occurred. Low eGFR and low lymphocyte count at the end of prophylaxis may help identify patients at higher risk of CMV disease.

Cited by 21 publications

References 47 publications

Impact assessment and investigation of factors associated with herpesviruses viremia in the first year of renal transplantation

Impact assessment and investigation of factors associated with herpesviruses viremia in the first year of renal transplantation

Burden and Timeline of Infectious Diseases in the First Year After Solid Organ Transplantation in the Swiss Transplant Cohort Study

A Nationwide Survey of Cytomegalovirus Prevention Strategies in Kidney Transplant Recipients in a Resource-Limited Setting

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