Limited impact of cytomegalovirus infection in the long-term outcome of renal and liver transplant

Juan, Rafael San; Dios, Begoña de; García‐Reyne, Ana; Fernández‐Ruiz, Mario; Lumbreras, Carlos; López‐Medrano, Francisco; Morales, José; Hernando, Susana; Folgueira, Lola; Jiménez, Carlos; Aguado, José María

doi:10.1016/j.jcv.2012.12.010

Cited by 12 publications

(11 citation statements)

References 23 publications

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“…In a smaller study of ϳ95 patients (DϩRϪ, DϩRϩ, DϪRϩ) of which 48 patients received prophylactic and 47 preemptive treatment, no difference in annual loss of GFR and graft loss up to 5 yr was observed (28). A third study of 104 patients with a follow-up to 7 yr (only high-risk group treated; DϩRϪ) confirmed these findings (22). The different design with shorter follow-up and smaller patient cohorts of the last two studies (22,28) could account for the different results.…”

Section: Vs 35 Ml•min ϫ1 •Yr ϫ1 )mentioning

confidence: 82%

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Long-term impact of CMV infection on allografts and on patient survival in renal transplant patients with protocol biopsies

Erdbrügger

Scheffner

Mengel

et al. 2015

American Journal of Physiology-Renal Physiology

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Cytomegalovirus (CMV) infection is a frequent complication of early posttransplantation. This study examines its impact on chronic allograft changes, long-term graft loss, and patient survival. We studied 594 patients who had protocol biopsies at 6 wk, and 3 and 6 mo posttransplantation. Chronic allograft changes were evaluated according to the updated Banff classification [interstitial fibrosis/tubular atrophy (IF/TA), vascular and glomerular lesions]. Follow-up data were available for up to 10 yr. CMV infection was diagnosed in 153 of 594 patients (26%) in the first year after transplantation, mostly within the first 3 mo. Graft survival was reduced in patients with CMV (P = 0.03) as well as the combined allograft/patient survival (P = 0.008). Prevalence of IF/TA at 6 wk after transplantation was already threefold higher in patients who experienced CMV infection later on compared with patients without CMV (P = 0.005). In multivariate analyses, CMV viremia or disease was not a significant factor for graft loss or death. In conclusion, patients with CMV infection posttransplantation show more chronic allograft changes early on, even before CMV infection, and development of IF/TA is not more prevalent in patients with CMV. Our data do not support a significant role of CMV in patient and graft outcomes.

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Section: Vs 35 Ml•min ϫ1 •Yr ϫ1 )mentioning

confidence: 82%

“…Studies differ in CMV screening protocols and drugs used for antiviral treatment. Different regimens for antiviral treatment have been examined, including treatment of CMV disease only, preemptive, and prophylactic treatment with variable durations of the prophylaxis (6,12,14,21,22,25,28).…”

Section: Vs 35 Ml•min ϫ1 •Yr ϫ1 )mentioning

confidence: 99%

Long-term impact of CMV infection on allografts and on patient survival in renal transplant patients with protocol biopsies

Erdbrügger

Scheffner

Mengel

et al. 2015

American Journal of Physiology-Renal Physiology

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“…However, the inconsistent timing of CMV testing may have modified the association between duration of CMV viraemia and outcome. Our study builds on the work of previous investigators [11, 12, 18–22], by being conducted at a time when all eligible renal transplant recipients were prescribed CMV prophylaxis, and by considering risk factors and consequences of CMV viraemia, rather than CMV disease.…”

Section: Discussionmentioning

confidence: 99%

“…An association between CMV disease and all-cause mortality has been previously shown, but less frequently for CMV viraemia alone [1, 11, 18, 20, 22, 31, 32], although these findings are not consistent across all studies [12]. Despite the routine use of antiviral prophylaxis after kidney transplantation in R+ and D+/R- recipients, 37% of recipients experienced CMV viraemia during the recommended period for antiviral prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

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Cytomegalovirus viraemia and mortality in renal transplant recipients in the era of antiviral prophylaxis. Lessons from the western Australian experience

et al. 2017

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BackgroundCytomegalovirus (CMV) establishes a lifelong infection that is efficiently controlled by the immune system; this infection can be reactivated in case of immunosuppression such as following solid organ transplantation. CMV viraemia has been associated with CMV disease, as well as increased mortality and allograft failure. Prophylactic antiviral medication is routinely given to renal transplant recipients, but reactivation during and following cessation of antiviral prophylaxis is known to occur. The aims of this study were to assess the incidence, timing and impact of CMV viraemia in renal transplant recipients and to determine the level of viraemia associated with adverse clinical outcomes.MethodsData from all adult (18 years and over) Western Australian renal transplant recipients transplanted between 1 January 2007 and 31 December 2012 were obtained from the Australia and New Zealand Dialysis and Transplant registry and were supplemented with data obtained from clinical records. Potential risk factors for detectable CMV viraemia (≥600 copies/ml) and all-cause mortality were assessed using univariable analysis and Cox Proportional Hazards Regression.ResultsThere were 438 transplants performed on 435 recipients. The following factors increased the risk of CMV viraemia with viral loads ≥600 copies/ml: Donor positive/Recipient negative status; receiving a graft from a deceased donor; and receiving a graft from a donor aged 60 years and over. CMV viraemia with viral loads ≥656 copies/ml was a risk factor for death following renal transplantation, as was being aged 65 years and above at transplant, being Aboriginal and having vascular disease. Importantly 37% of the episodes of CMV viraemia with viral loads ≥656 copies/ml occurred while the patients were expected to be on CMV prophylaxis.ConclusionsCMV viraemia (≥656 copies/ml) was associated with all-cause mortality in multivariable analysis, and CMV viraemia at ≥656 copies/ml commonly occurred during the period when renal transplant recipients were expected to be on antiviral prophylaxis. A greater vigilance in monitoring CMV levels if antiviral prophylaxis is stopped prematurely or poor patient compliance is suspected could protect some renal transplant recipients from adverse outcomes such as premature mortality.

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Clinical Experience with Immune Monitoring for Cytomegalovirus in Solid-Organ Transplant Recipients

Manuel

2013

Curr Infect Dis Rep

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Novel strategies are needed to further reduce the burden of cytomegalovirus (CMV) disease in solid-organ transplant (SOT) recipients. Measurement of the specific cell-mediated immunity against CMV can identify the actual risk for the development of CMV disease in a given patient. Thus, immune monitoring is an attractive strategy for individualizing the management of CMV after transplantation. A growing number of observational studies on immune monitoring for CMV have been published over recent years, although there is a lack of data coming from interventional trials. In high-risk patients, measurement of CMV-specific T-cell responses appropriately stratifies the risk of CMV disease after discontinuation of antiviral prophylaxis. Immune monitoring may also help to identify patients followed by the preemptive approach at low risk for progression to CMV disease. Pretransplant assessment of cell-mediated immunity in seropositive patients may predict the development of posttransplant CMV infection. Overall, these studies indicate that the use of cell-mediated immunity assays has the potential to improve the management of CMV disease in SOT recipients.

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Limited impact of cytomegalovirus infection in the long-term outcome of renal and liver transplant

Cited by 12 publications

References 23 publications

Long-term impact of CMV infection on allografts and on patient survival in renal transplant patients with protocol biopsies

Long-term impact of CMV infection on allografts and on patient survival in renal transplant patients with protocol biopsies

Cytomegalovirus viraemia and mortality in renal transplant recipients in the era of antiviral prophylaxis. Lessons from the western Australian experience

Clinical Experience with Immune Monitoring for Cytomegalovirus in Solid-Organ Transplant Recipients

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