Long-Term Outcomes of CMV Disease Treatment with Valganciclovir Versus IV Ganciclovir in Solid Organ Transplant Recipients

Åsberg, Anders; Humar, Atul; Jardine, Alan G.; Rollag, Halvor; Pescovitz, Mark D.; Mouas, H.; Bignamini, A; Töz, Hüseyin; Dittmer, Ian; Montejo, Miguel; Hartmann, Anders

doi:10.1111/j.1600-6143.2009.02617.x

Cited by 162 publications

(130 citation statements)

References 39 publications

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“…In the randomized VIC-TOR trial comparing IV ganciclovir versus valganciclovir in the treatment of CMV disease, only 58% of patients had viral eradication at day 21, and 85% had viral eradication at day 49 (37). In this study, we showed that median treatment duration to stop viral replication in D+RÀ patients is 40 days in LOD versus 60 days in EOD.…”

Section: Discussionmentioning

confidence: 57%

“…This suggests that in LOD, the control of infection is more effective and easier to implement compared with EOD. Recurrences of CMV infection are another worrying problem in the management of KTRs, with a previously described frequency of %30% (37,38), but analysis following EOD versus LOD had not yet been achieved. In this study, we found that EOD was associated with a very high rate (80%) of CMV DNAemia recurrence and with 30% of symptomatic recurrences, complicating the management of these patients.…”

Section: Discussionmentioning

confidence: 99%

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Easier Control of Late-Onset Cytomegalovirus Disease Following Universal Prophylaxis Through an Early Antiviral Immune Response in Donor-Positive, Recipient-Negative Kidney Transplants

Kaminski

Couzi

Garrigue³

et al. 2016

American Journal of Transplantation

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Universal prophylaxis for cytomegalovirus (CMV) prevention is viable but, compared with a preemptive strategy, leads to higher incidence of late-onset disease (LOD) associated with poor patient and graft survival. The purpose of this study was to compare LOD with early onset disease (EOD), with a focus on the highest risk kidney transplant recipients (KTRs): CMV seronegative recipients transplanted from seropositive donors (D+RÀ). Since CMV control depends on both antiviral treatment and specific immune response, we also compared Vd2-negative (Vd2 neg ) cd T cell expansion involved in CMV infection resolution. EOD was defined as occurring <3 mo and LOD as occurring >3 mo after transplantation. Depending on the period, universal prophylaxis or preemptive treatment was used. Overall, 168 D+RÀ KTRs were included between 2003 and 2011. LOD was associated with a lower peak DNAemia (p = 0.04), fewer recurrences (odds ratio 0.16; 95% confidence interval 0.05-0.55; p = 0.01) and shorter anti-CMV curative treatment (40 vs. 60 days, p < 0.0001). As a corollary, we found that Vd2 neg cd T cell expansion was faster in LOD than in EOD (31 vs. 168 days after the beginning of CMV disease, p < 0.0001). In D+RÀ KTRs, universal prophylaxis is associated with more LOD, which had better infection management and a faster immune response. These results support the use of universal prophylaxis over a preemptive strategy and reappraise outcomes of LOD.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Easier Control of Late-Onset Cytomegalovirus Disease Following Universal Prophylaxis Through an Early Antiviral Immune Response in Donor-Positive, Recipient-Negative Kidney Transplants

Kaminski

Couzi

Garrigue³

et al. 2016

American Journal of Transplantation

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“…Valganciclovir is known to cause anemia and leucopenia, but in severe cases involving improper dosing, fatalities have been reported [14]. In-vitro studies have shown that ganciclovir inhibits T-lymphocyte activation and proliferation at therapeutic concentrations [15].…”

Section: Discussionmentioning

confidence: 99%

“…Treatment of CMV disease usually includes stopping lymphocyte-depleting therapy, reducing the dose of other immunosuppressive medications, and instituting antiviral therapy [14,17]. During treatment, the PCR is followed to verify that the virus is responding to the drug.…”

Section: Discussionmentioning

confidence: 99%

A Case of Cytomegalovirus-Induced Arthritis after Lymphocyte-Depleting Therapy for Kidney Allograft Rejection

Fuquay¹,

Cooper²

2012

OJNeph

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Cytomegalovirus viremia and tissue-invasive disease are common after kidney transplantation. Chemoprophylaxis has made substantial improvement in this clinical problem. Here we report a 29-year-old woman who had kidney allograft rejection and received lymphocyte-depleting therapy. She presented with a new oligo-arthritis that led to 2 successive arthrocenteses. The etiology of the inflammation could not be determined initially. On the second arthrocentesis, a synovial fluid cytomegalovirus polymerase chain reaction test was positive. The patient responded to treatment with valganciclovir, had negative follow-up serum cytomegalovirus polymerase chain reaction tests, and experienced resolution of her joint inflammation. We review briefly the data for cytomegalovirus chemoprophylaxis, preemptive screening, and treatment recommendations.

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“…Finally, we used two different rather diverse approaches to define treatment failure and found consistent results for our main finding. However, currently there is no consensus on how to define treatment failure in CMV infection and the definitions vary by as much as persistence of viremia from 2 to 8 weeks after initiation of treatment (8,22,23). In order to optimize guidelines on how to interpret evolution of CMV viral load during course of treatment, more evidence variation in clinical and virological (i.e.…”

Section: Discussionmentioning

confidence: 99%

The Time Course of Development and Impact From Viral Resistance Against Ganciclovir in Cytomegalovirus Infection

Cunha‐Bang

Kirkby²,

Sønderholm

et al. 2013

American Journal of Transplantation

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Long-Term Outcomes of CMV Disease Treatment with Valganciclovir Versus IV Ganciclovir in Solid Organ Transplant Recipients

Cited by 162 publications

References 39 publications

Easier Control of Late-Onset Cytomegalovirus Disease Following Universal Prophylaxis Through an Early Antiviral Immune Response in Donor-Positive, Recipient-Negative Kidney Transplants

Easier Control of Late-Onset Cytomegalovirus Disease Following Universal Prophylaxis Through an Early Antiviral Immune Response in Donor-Positive, Recipient-Negative Kidney Transplants

A Case of Cytomegalovirus-Induced Arthritis after Lymphocyte-Depleting Therapy for Kidney Allograft Rejection

The Time Course of Development and Impact From Viral Resistance Against Ganciclovir in Cytomegalovirus Infection

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