Pre-emptive intravenous ganciclovir versus valganciclovir prophylaxis for de novo cytomegalovirus-seropositive kidney-transplant recipients

Wéclawiak, Hugo; Kamar, Nassim; Mengelle, Catherine; Esposito, Laure; Mohamed, Abdel‐Latif; Lavayssière, Laurence; Ribes, David; Cointault, Olivier; Nogier, Marie-Béatrice; Cardeau-Desangles, Isabelle; Izopet, Jacques; Rostaing, Lionel

doi:10.1111/j.1432-2277.2010.01101.x

Cited by 19 publications

(18 citation statements)

References 29 publications

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“…However, no symptomatic infections or seroconversions occurred during prophylaxis. There was no significant correlation between serostatus and CMV infection in contrast to previous reports . The significant association of the D+/R− combination to increase CMV DNAemia in patients of all ages despite prophylaxis has been shown in multiple past studies .…”

Section: Discussioncontrasting

confidence: 72%

“…Leukopenia, neutropenia, anemia, thrombocytopenia, pancytopenia, bone marrow aplasia, and aplastic anemia have been observed with ValGCV use . In this study, the level of predicted ValGCV dosage was significantly associated with neutropenia.…”

Section: Discussionmentioning

confidence: 52%

“…This study of the course of CMV and EBV infection in children after kidney transplantation suggests ValGCV use is an effective prophylaxis for CMV infection . It appears that 5‐ to 12‐month prophylaxis is adequate as previously suggested .…”

Section: Discussionmentioning

confidence: 74%

“…In the recent transplant era, serial PCR viral load monitoring and prophylactic antiviral use have altered the management and outcomes of infection . Available literature on management and epidemiology in this era mainly concerns adult populations and high‐risk serostatus groups (D+/R−) .…”

Section: Introductionmentioning

confidence: 99%

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The efficacy of valganciclovir for prevention of infections with cytomegalovirus and Epstein‐Barr virus after kidney transplant in children

Cameron

Kennedy

Rawlinson

et al. 2016

Pediatric Transplantation

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This study evaluated the efficacy of prophylactic ValGCV in preventing CMV and EBV infections in a single-center pediatric kidney transplant population (2008-2014). Therapy duration was determined according to donor/recipient serostatus. EBV monitoring was performed using monthly plasma PCR for 18 months post-transplant and for CMV, monthly for 6 months after prophylaxis cessation. Data were collected on 35 children, median age 10.6 years. There were 15 (42.9%) and 11 (31.4%) recipients seronegative for CMV or EBV, respectively, who received a kidney from a seropositive donor. Prophylaxis was ceased by 6 months in 24 (69%), between seven and 13 months in 10 (29%) children. Fourteen (40%) and eight (23%) children experienced CMV and EBV DNAemia, respectively. Ten of the 14 (71%) episodes of CMV DNAemia occurred in the first 6 months following cessation of prophylaxis. Shorter prophylaxis was associated with increased CMV DNAemia (P = 0.044). There was an inverse correlation between adjusted ValGCV dose and EBV incidence/timing. Neutropenia was more common if ValGCV dosage was ≥10% of the dose predicted (by BSA and creatinine clearance). ValGCV prevents CMV and may modify EBV infection risk. Frequent dosing adjustment for BSA and creatinine clearance is required to optimize safety and efficacy.

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Section: Discussioncontrasting

confidence: 72%

Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 74%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The efficacy of valganciclovir for prevention of infections with cytomegalovirus and Epstein‐Barr virus after kidney transplant in children

Cameron

Kennedy

Rawlinson

et al. 2016

Pediatric Transplantation

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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%

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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Consenso colombiano para la estratificación, diagnóstico, tratamiento y prevención de la infección por citomegalovirus en pacientes adultos con trasplante renal

et al. 2016

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Pre-emptive intravenous ganciclovir versus valganciclovir prophylaxis for de novo cytomegalovirus-seropositive kidney-transplant recipients

Cited by 19 publications

References 29 publications

The efficacy of valganciclovir for prevention of infections with cytomegalovirus and Epstein‐Barr virus after kidney transplant in children

The efficacy of valganciclovir for prevention of infections with cytomegalovirus and Epstein‐Barr virus after kidney transplant in children

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

Consenso colombiano para la estratificación, diagnóstico, tratamiento y prevención de la infección por citomegalovirus en pacientes adultos con trasplante renal

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