Effect of Cytomegalovirus Infection on Survival of Older Kidney Transplant Patients (D+/R+): Impact of Valganciclovir Prophylaxis Versus Preemptive Therapy

Luna, Enrique; Caravaca, Francisco; Ferreira, F.; Fernandez, N Curbelos; Martin, Pierre Yves; Vargas, Marı́a Luisa; Santamaría, Javier Sáenz de; Pino, G; Azevedo, Lilia; Sanz, Agustín Muñoz

doi:10.1016/j.transproceed.2016.06.062

Cited by 14 publications

(6 citation statements)

References 32 publications

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“…In the same group, corticosteroids were more often used as a maintenance therapy. Using cyclosporine instead of tacrolimus is not described as an independent risk factor for CMV reactivation, 14,16,17 except in one study, with a protective effect of cyclosporine. The use of corticosteroids 12 as a maintenance therapy is not an independent risk factor in any of the studies.…”

Section: Discussionmentioning

confidence: 98%

“…Thirdly, CMV infection is thought to impact patient survival, 20,26 not only because of death directly as a result of CMV disease, but also because it increases atherosclerosis and cardiovascular mortality. 16 At the beginning of the 1990s, one study reported poorer patient survival in a CMV D+/R+ renal transplant recipient group in comparison to a CMV D+/R− group. 27 The reason was unclear, possibly because of a dual CMV exposure leading to more frequent CMV asymptomatic reactivations.…”

Section: Discussionmentioning

confidence: 99%

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Among CMV‐positive renal transplant patients receiving non‐T‐cell depleting induction, the absence of CMV disease prevention is a safe strategy: A retrospective cohort of 372 patients

Boulay

Oger²,

Cantarovich

et al. 2021

Transplant Infectious Dis

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Cytomegalovirus (CMV) is the most common opportunistic pathogen affecting renal transplant recipients, especially in the first months. CMV-seropositive renal transplant recipients (CMV R+) are at intermediate risk for CMV disease, but this risk is enhanced among CMV R+ receiving T-cell depleting induction, compared to CMV R+ receiving non-depleting induction. In this second group, data in favor of prophylactic antiviral treatment with valganciclovir to reduce CMV disease is sparse. In this retrospective and multicentric trial, we included 372 CMV R+ transplanted between January 2012 and April 2015 and receiving non-depleting induction. During the first year following transplantation, CMV disease occurred in 5/222 patients (2.25%) in the prophylaxis group and 9/150 (6%) in the no-prophylaxis group (difference +3.7; 95% CI: 0.5-8; P = .002 for non-inferiority). The incidence of allograft rejection and other infectious diseases was similar between the two groups. Graft and patient survival were similar at the end of follow-up. In conclusion, the absence of prophylaxis did not appear to have a deleterious effect for CMV diseases among CMV R+ receiving non-depleting induction.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Among CMV‐positive renal transplant patients receiving non‐T‐cell depleting induction, the absence of CMV disease prevention is a safe strategy: A retrospective cohort of 372 patients

Boulay

Oger²,

Cantarovich

et al. 2021

Transplant Infectious Dis

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“…Although these results are consistent with a previous study (28.4% versus 23.2% for leukopenia), 5 they are contradictory with other studies, in which no difference was reported. 5,31 Furthermore, no significant difference between groups was found on the number and length of hospitalization, suggesting that these adverse events did not lead to hospitalization or prolongation of hospitalization. Overall, this suggests that despite the risk of leukopenia or neutropenia, prophylaxis is worth being favored.…”

Section: Discussionmentioning

confidence: 91%

The Cost-effectiveness of Valganciclovir Prophylaxis Versus Preemptive Therapy in CMV R+ Kidney Transplant Recipients Over the First Year Posttransplantation

Villeneuve,

Rerolle,

Couzi

et al. 2024

Transplantation Direct

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Background. In kidney transplant recipients with positive serology (R+) for the cytomegalovirus (CMV), 2 strategies are used to prevent infection, whose respective advantages over the other are still debated. This study aimed to evaluate the cost-effectiveness and cost utility of antiviral prophylaxis against CMV versus preemptive therapy, considering CMV infection–free survival over the first year posttransplantation as the main clinical outcome. Methods. Clinical, laboratory, and economic data were collected from 186 kidney transplant patients CMV (R+) included in the cohort study (85 patients who benefited from CMV prophylaxis and 101 from preemptive therapy). Costs were calculated from the hospital perspective and quality-adjusted life years (QALYs) using the EQ5D form. Using nonparametric bootstrapping, the incremental cost-effectiveness ratio (ICER) and cost utility were estimated (euros) for each case of infection avoided and each QALY gained for 1 y, respectively. Results. Prophylaxis significantly decreased the risk of CMV infection over the first year posttransplantation (hazard ratio 0.22, 95% confidence interval = 0.12-0.37, P < 0.01). Compared with preemptive therapy, prophylaxis saved financial resources (€1155 per patient) and was more effective (0.42 infection avoided per patient), resulting in an ICER = €2769 per infection avoided. Prophylaxis resulted in a net gain of 0.046 in QALYs per patient and dominated over preemptive therapy with €1422 cost-saving for 1 QALY gained. Conclusions. This study shows that CMV prophylaxis, although considered as a more expensive strategy, is more cost-effective than preemptive therapy for the prevention of CMV infections in renal transplant patients. Prophylaxis had a positive effect on quality of life at reasonable costs and resulted in net savings for the hospital.

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“…Five studies were open‐label RCTs . Of the observational studies, five had a retrospective cohort design and one a prospective cohort design . Four RCTs and one observational study included both CMV‐seropositive and ‐seronegative recipients, while the others restricted the study populations to only seropositive recipients.…”

Section: Resultsmentioning

confidence: 99%

“…Cytomegalovirus viremia is a significant complication of kidney transplantation; without antiviral intervention, it develops among two‐thirds of recipients . Studies among renal transplant patients demonstrated an association between CMV disease and allograft outcomes . Therefore, prophylaxis with an appropriate antiviral drug, such as ganciclovir, is the suggested standard care for renal transplant recipients .…”

Section: Introductionmentioning

confidence: 99%

Comparison of universal prophylaxis and preemptive approach for cytomegalovirus associated outcome measures in renal transplant patients: A meta‐analysis of available data

Çaşkurlu

Karadağ

Arslan

et al. 2018

Transplant Infectious Dis

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Cytomegalovirus (CMV) is a ubiquitous latent human virus that often causes complications in renal transplantation recipients. Universal prophylaxis and preemptive therapy are alternative strategies to prevent CMV associated complications. This meta‐analysis aimed to assess available data comparing the effectiveness of prophylaxis and preemptive therapy for preventing adverse outcomes. We searched the PubMed, Ovid, Web of Science, Cochrane Library, and Open Grey databases using a combination of keywords. Random effects models along with the Paule‐Mandel estimator were used to synthesize pooled effect estimates. Eleven studies were eligible for the final analysis. Universal prophylaxis was better at preventing CMV disease than the preemptive approach (risk difference = −0.0459; confidence intervals = −0.0791, −0.0127; P‐value = 0.0067; number needed to treat [NNT] = 22 [1/0.0459]; high, 79 [1/0.0127] patients; low, 13 [1/0.0791] patients). Subgroup analysis revealed a more consistent effect among studies published after 2010, with negligible between‐study heterogeneity. The NNT for universal prophylaxis to prevent one excess CMV disease concerning preemptive therapy was 16 (1/0.0630) patients (high, 25 [1/0.0394]; low, 12 [1/0.0867] patients) in the subgroup of studies performed after 2010. We detected no significant difference between the two strategies regarding acute rejection and graft loss, with negligible variability due to heterogeneity between studies. Although universal prophylaxis performed better than the preemptive strategy for the prevention of CMV disease, the high NNT value may discourage the use of CMV prophylaxis. Since there were no differences between the strategies concerning acute rejection and graft loss, this study supports the use of the preemptive approach as an alternative to universal prophylaxis.

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Effect of Cytomegalovirus Infection on Survival of Older Kidney Transplant Patients (D+/R+): Impact of Valganciclovir Prophylaxis Versus Preemptive Therapy

Cited by 14 publications

References 32 publications

Among CMV‐positive renal transplant patients receiving non‐T‐cell depleting induction, the absence of CMV disease prevention is a safe strategy: A retrospective cohort of 372 patients

Among CMV‐positive renal transplant patients receiving non‐T‐cell depleting induction, the absence of CMV disease prevention is a safe strategy: A retrospective cohort of 372 patients

The Cost-effectiveness of Valganciclovir Prophylaxis Versus Preemptive Therapy in CMV R+ Kidney Transplant Recipients Over the First Year Posttransplantation

Comparison of universal prophylaxis and preemptive approach for cytomegalovirus associated outcome measures in renal transplant patients: A meta‐analysis of available data

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