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

Paula, Mayara Ivani de; Bowring, Mary G.; Shaffer, Ashton A.; Bessa, Adrieli; Felipe, Cláudia Rosso; Cristelli, Marina Pontello; Massie, Allan B.; Medina‐Pestana, José Osmar; Segev, Dorry L.; Tedesco‐Silva, Hélio

doi:10.1111/tri.13800

Cited by 7 publications

(6 citation statements)

References 39 publications

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“…The observed 3-years graft, death-censored graft and patient survivals were comparable with that reported by the SRTR data [ 14 ]. These data are concordant with two other retrospective analysis in low-risk [ 15 ] and high-risk [ 16 ] kidney transplant recipients in our institution.…”

Section: Discussionsupporting

confidence: 92%

The influence of the antithymocyte globulin dose on clinical outcomes of patients undergoing kidney retransplantation

et al. 2021

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Optimizing antithymocyte globulin (rATG) dosage is critical for high immunological risk patients undergoing a repeat kidney transplant. This natural retrospective cohort study compared clinical outcomes of two successive cohorts of consecutive recipients of retransplants receiving 5 x 1 mg/kg (rATG-5, n = 100) or a single 3 mg/kg (rATG-3, n = 110) dose of rATG induction therapy. All patients had negative complement-dependent cytotoxicity crossmatch and no anti-HLA A, B, DR donor-specific antibodies (DSA). The primary endpoint was efficacy failure (first biopsy-proven acute rejection, graft loss, or death) at 12 months. There was no difference in the cumulative incidence of efficacy failure (18.0% vs. 21.8%, HR = 1.22, 95% CI 0.66–2.25), respectively. There were no differences in 3-years freedom from biopsy proven acute rejection, and patient, graft, and death-censored graft survivals. There were no differences in the incidence of surgical complications (25.0% vs. 18.2%; p 0.151), early hospital readmission (27.8% vs. 29.5%; p = 0.877) and CMV infections (49% vs. 40%; p = 0.190). There were also no differences in the incidence (59.6% vs. 58.7%, p = 0.897) and duration of delayed graft function but a stable difference in estimate glomerular filtration rate was observed from month 1 (54.7±28.8 vs. 44.1±25.3 ml/min/1.73 m2, p = 0.005) to month 36 (51.1±27.7 vs. 42.5±24.5, p = 0.019). Mean urinary protein concentration (month 36: 0.38±0.81 vs. 0.70±2.40 g/ml, p = 0.008) and mean chronic glomerular Banff score in for cause biopsies (months 4–36: 0.0±0.0 vs. 0.04±0.26, p = 0.044) were higher in the rATG-3 group. This cohort analysis did not detect differences in the incidence of efficacy failure and in safety outcomes at 12 months among recipients of kidney retransplants without A, B, and DR DSA, receiving induction therapy with a single 3 mg/kg rATG dose or the traditional 5 mg/kg rATG.

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Section: Discussionsupporting

confidence: 92%

The influence of the antithymocyte globulin dose on clinical outcomes of patients undergoing kidney retransplantation

et al. 2021

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“…The diagnostic criteria used for ascertaining CMV infection were similar across studies—whereby a patient was considered to have CMV infection through a positive PCR and/or pp65‐antigenemia assay for CMV. However, specimens used for these analyses varied extensively, consisting of either whole blood, plasma, serum, or body fluid, collected periodically during CMV monitoring (frequency and duration of monitoring were not reported) 21–22,24–26,28–35,37,40,41 . In addition, thresholds used to determine whether a patient was positive on the quantitative PCR assay were heterogeneous—such as ≥500 copies/mL (South Korea), 31 ≥1000 copies/mL (India), 24 or >2.500 international units (Brazil) 8,41 .…”

Section: Resultsmentioning

confidence: 99%

“…In patients receiving prophylaxis (5 studies), reported rates of CMV infection during the first year post‐SOT were 5.2%, 30 26.0%, 24 45.4%, 31 50.0%, 22 and 50.2% 32 . According to studies conducted in Brazil, India, and South Korea, infection typically appeared after a median of 1–2 months postkidney or postliver transplantation 8,21,25,27,29,32–39 . The diagnostic criteria used for ascertaining CMV infection were similar across studies—whereby a patient was considered to have CMV infection through a positive PCR and/or pp65‐antigenemia assay for CMV.…”

Section: Resultsmentioning

confidence: 99%

Epidemiology, management, and burden of cytomegalovirus in solid organ transplant recipients in selected countries outside of Europe and North America: A systematic review

Silva

Tokat

Cai

et al. 2023

Transplant Infectious Dis

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BackgroundCytomegalovirus (CMV) is a frequent infectious complication following solid organ transplantation (SOT). Considering significant differences in healthcare systems, a systematic review was conducted to describe the epidemiology, management, and burden of CMV post‐SOT in selected countries outside of Europe and North America.MethodsMEDLINE, Embase, and Cochrane databases were searched for observational studies in SOT recipients across 15 countries in the regions of Asia, Pacific, and Latin America (search period: January 1, 2011 to September 17, 2021). Outcomes included incidence of CMV infection/disease, recurrence, risk factors, CMV‐related mortality, treatment patterns and guidelines, refractory and/or resistant CMV, patient‐reported outcomes, and economic burden.ResultsOf 2708 studies identified, 49 were eligible (n = 43/49; 87.8% in adults; n = 34/49, 69.4% in kidney recipients). Across studies, selection of CMV preventive strategy was based on CMV serostatus. Overall, rates of CMV infection (within 1 year) and CMV disease post‐SOT were respectively, 10.3%–63.2% (9 studies) and 0%–19.0% (17 studies). Recurrence occurred in 35.4%–41.0% cases (3 studies) and up to 5.3% recipients died of CMV‐associated causes (11 studies). Conventional treatments for CMV infection/disease included ganciclovir (GCV) or valganciclovir. Up to 4.4% patients were resistant to treatment (3 studies); no studies reported on refractory CMV. Treatment‐related adverse events with GCV included neutropenia (2%–29%), anemia (13%–48%), leukopenia (11%–37%), and thrombocytopenia (13%–24%). Data on economic burden were scarce. imageConclusionOutside of North America and Europe, rates of CMV infection/disease post‐SOT are highly variable and CMV recurrence is frequent. CMV resistance and treatment‐associated adverse events, including myelosuppression, highlight unmet needs with conventional therapy.

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“…All patients received a single dose of 3.0 mg/kg of Thymoglobulin as an induction strategy, following the local practice, which was previously published 26 – 28 . The maintenance immunosuppression regime consisted of a combination of tacrolimus, prednisone, and acid mycophenolate.…”

Section: Methodsmentioning

confidence: 99%

Transition from antigenemia to quantitative nucleic acid amplification testing in cytomegalovirus-seropositive kidney transplant recipients receiving preemptive therapy for cytomegalovirus infection

Nakamura

Requião-Moura

Gallo

et al. 2022

Sci Rep

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Due to the high costs, the strategy to reduce the impact of cytomegalovirus (CMV) after kidney transplant (KT) involves preemptive treatment in low and middle-income countries. Thus, this retrospective cohort study compared the performance of antigenemia transitioned to quantitative nucleic acid amplification testing, RT-PCR, in CMV-seropositive KT recipients receiving preemptive treatment as a strategy to prevent CMV infection. Between 2016 and 2018, 363 patients were enrolled and received preemptive treatment based on antigenemia (n = 177) or RT-PCR (n = 186). The primary outcome was CMV disease. Secondarily, the CMV-related events were composed of CMV-infection and disease, which occurred first. There were no differences in 1-year cumulative incidence of CMV-disease (23.7% vs. 19.1%, p = 0.41), CMV-related events (50.8% vs. 44.1%, p = 0.20), neither in time to diagnosis (47.0 vs. 47.0 days) among patients conducted by antigenemia vs. RT-PCR, respectively. The length of CMV first treatment was longer with RT-PCR (20.0 vs. 27.5 days, p < 0.001), while the rate of retreatment was not different (14.7% vs. 11.8%, p = 0.48). In the Cox regression, acute rejection within 30 days was associated with an increased the risk (HR = 2.34; 95% CI = 1.12–4.89; p = 0.024), while each increase of 1 mL/min/1.73 m2 of 30-day eGFR was associated with a 2% reduction risk of CMV-disease (HR = 0.98; 95% CI = 0.97–0.99; p = 0.001). In conclusion, acute rejection and glomerular filtration rate are risk factors for CMV disease, showing comparable performance in the impact of CMV-related events between antigenemia and RT-PCR for preemptive treatment.

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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

Cited by 7 publications

References 39 publications

The influence of the antithymocyte globulin dose on clinical outcomes of patients undergoing kidney retransplantation

The influence of the antithymocyte globulin dose on clinical outcomes of patients undergoing kidney retransplantation

Epidemiology, management, and burden of cytomegalovirus in solid organ transplant recipients in selected countries outside of Europe and North America: A systematic review

Transition from antigenemia to quantitative nucleic acid amplification testing in cytomegalovirus-seropositive kidney transplant recipients receiving preemptive therapy for cytomegalovirus infection

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