Pre-emptive treatment for cytomegalovirus viraemia to prevent cytomegalovirus disease in solid organ transplant recipients

Owers, Daniel S.; Webster, Angela C; Strippoli, Giovanni F.M.; Kable, Kathy; Hodson, Elisabeth M

doi:10.1002/14651858.cd005133.pub3

Cited by 81 publications

(65 citation statements)

References 126 publications

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“…Preemptive CMV treatment, without the employment of specific CMV prophylaxis is an accepted strategy for minimizing the effects of infection and is employed for lower risk patients or when prophylaxis is not affordable . Relevant clinical endpoints are similar to those obtained with prophylaxis, except for CMV replication rates . However, as a result of permissive CMV replication using this strategy, late infections tend to be rare and very little is known about its clinical course.…”

Section: Discussionmentioning

confidence: 69%

Late cytomegalovirus (CMV) infections after kidney transplantation under the preemptive strategy: Risk factors and clinical aspects

Ono

Pestana

Camargo

2018

Transplant Infectious Dis

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Background Late cytomegalovirus infections (LCMV) after the cessation of prophylaxis are well described. We aimed to assess clinical and epidemiological data on late‐occurring cytomegalovirus (CMV) infections in the absence of CMV prophylaxis in a cohort of kidney transplant patients. Methods In a cohort of kidney transplant recipients not employing CMV‐specific prophylaxis, patients with CMV infections occurring after 6 months of transplantation were compared to patients with CMV infections diagnosed within the first 6 months (early infections). The main objectives were to compare clinical outcomes and evaluate risk factors for late CMV infection. Results A total of 556 patients were evaluated. Forty‐three patients with LCMV infections were compared to 513 patients with early CMV infections. LCMV infections occurred after a median of 473 days of transplantation and had a more severe course, with a statistically significant higher rate of invasive disease and graft loss (60.5% vs 21.6% and 11.6% vs 3.1% respectively). Thirty‐day mortality was twice as high for patients with LCMV, but did not reach statistical significance (9.3% vs 4.3%). By multivariate analysis, employment of antilymphocyte therapy early after transplantation and tacrolimus as initial immunosuppressive therapy were significantly protective for the occurrence of LCMV infections. Conclusion Late CMV infections in the absence of specific prophylaxis after kidney transplantation have a more severe outcome when compared to early infections and occur in patients less immunosuppressed early after transplantation.

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Section: Discussionmentioning

confidence: 69%

Late cytomegalovirus (CMV) infections after kidney transplantation under the preemptive strategy: Risk factors and clinical aspects

Ono

Pestana

Camargo

2018

Transplant Infectious Dis

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“…13,14 Efficacy of ganciclovir has been clearly demonstrated across all solid organ transplantation, by preventing CMV infection and disease and by improving survival. Two recent comprehensive systematic reviews 15,16 found that ganciclovir prophylaxis is superior to 17 18,19 .…”

Section: (Val) Ganciclovirmentioning

confidence: 99%

“…[88][89][90] In seropositive heart recipients, both approaches appear to be effective for prevention of the direct effects of acute CMV infection (i.e. CMV syndrome or CMV disease), 15 Effective pre-emptive approach needs an experienced virology laboratory with short turnaround times to process frequent assays, intensive cross-talking between clinicians and laboratory professionals, and strict patient adherence to scheduled blood/tissue sampling. In this setting, historical methods such as shell vial assay or pp65 antigenemia should be replaced by blood polymerase chain reaction (PCR) [96][97][98][99] .…”

Section: Targets and Strategies In Anti-cmv Therapy: Prophylaxis Vs mentioning

confidence: 99%

Treatment and prevention of cytomegalovirus infection in heart and lung transplantation: an update

Potena¹,

Solidoro

Patrucco

et al. 2016

Expert Opinion on Pharmacotherapy

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“…The incidence of CMV infection has been reported to decrease in patients treated with mammalian target of rapamycin–targeting drugs . On the other hand, posttransplant surveillance of viremia in CMV+ KTR allows early detection of viral replication and administration of preemptive therapy …”

Section: Introductionmentioning

confidence: 99%

Pretransplant adaptive NKG2C+ NK cells protect against cytomegalovirus infection in kidney transplant recipients

Ataya

Redondo‐Pachón

Llinàs‐Mallol

et al. 2020

American Journal of Transplantation

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Cytomegalovirus (CMV) infection constitutes a complication for kidney transplant recipients (KTR) and CMV‐specific T cells reduce the risk of viral replication in seropositive patients. CMV promotes the adaptive differentiation and expansion of an NK cell subset, hallmarked by expression of the CD94/NKG2C receptor with additional characteristic features. We previously reported an association of pretransplant NKG2C+ NK cells with a reduced incidence of CMV infection. We have strengthened the analysis in cryopreserved peripheral blood mononuclear cells from an enlarged KTR cohort (n = 145) with homogeneous immunosuppression, excluding cases at low risk of infection (ie, CMV D−R−) or receiving antiviral prophylaxis. Moreover, adaptive NKG2C+ NK cell–associated markers (ie, NKG2A, CD57, Immunoglobulin‐like transcript 2 [LIR1 or LILRB1], FcεRI γ chain, and Prolymphocytic Leukemia Zinc Finger transcription factor) as well as T lymphocyte subsets were assessed by multicolor flow cytometry. The relation of NKG2C+ NK cells with T cells specific for CMV antigens was analyzed in pretransplant patients (n = 29) and healthy controls (n = 28). Multivariate Cox regression and Kaplan‐Meier analyses supported that NKG2C+ NK cells bearing adaptive markers were specifically associated with a reduced incidence of posttransplant symptomatic CMV infection; no correlation between NKG2C+ NK cells and CMV‐specific T cells was observed. These results support that adaptive NKG2C+ NK cells contribute to control CMV infection in KTR.

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Pre-emptive treatment for cytomegalovirus viraemia to prevent cytomegalovirus disease in solid organ transplant recipients

Abstract: Pre-emptive treatment for cytomegalovirus viraemia to prevent cytomegalovirus disease in solid organ transplant recipients (Review)

Cited by 81 publications

References 126 publications

Late cytomegalovirus (CMV) infections after kidney transplantation under the preemptive strategy: Risk factors and clinical aspects

Late cytomegalovirus (CMV) infections after kidney transplantation under the preemptive strategy: Risk factors and clinical aspects

Treatment and prevention of cytomegalovirus infection in heart and lung transplantation: an update

Pretransplant adaptive NKG2C+ NK cells protect against cytomegalovirus infection in kidney transplant recipients

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