Prevention of Cytomegalovirus-Related Death by Passive Immunization

Metselaar, Herold J.; Rothbarth, P. H.; Brouwer, R.; Wenting, G J; Jeekel, J.; Weimar, W

doi:10.1097/00007890-198908000-00016

Cited by 49 publications

(14 citation statements)

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“…Full-text assessment of 15 potentially eligible articles identified 11 trials including 698 patients (Table 1). Studies compared CMVIG with placebo or no treatment (7,(9)(10)(11)(12)(13)(14)(15). Two additional trials compared CMVIG with acyclovir (16,17).…”

Section: Description Of the Studiesmentioning

confidence: 99%

CMV‐hyperimmune globulin for preventing cytomegalovirus infection and disease in solid organ transplant recipients: a meta‐analysis

Bonaros

Mayer

Schachner

et al. 2007

Clinical Transplantation

137

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Section: Description Of the Studiesmentioning

confidence: 99%

CMV‐hyperimmune globulin for preventing cytomegalovirus infection and disease in solid organ transplant recipients: a meta‐analysis

Bonaros

Mayer

Schachner

et al. 2007

Clinical Transplantation

137

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“…CMV immune globulin was given preemptively in a double‐blind placebo‐controlled study of kidney recipients receiving RATG for acute rejection ( 45). No difference was seen in the incidence of CMV disease between the placebo and the treatment arm, but IVIG had a protective effect in reducing CMV‐associated mortality in seronegative recipients of seropositive organs ( 45).…”

Section: Selected Trials Of Preemptive Therapy In Solid Organsmentioning

confidence: 99%

Prevention and treatment of cytomegalovirus infection in organ transplant recipients

Kusne

Shapiro

Fung

1999

Transplant Infectious Dis

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Cytomegalovirus (CMV) is the most common viral pathogen in organ transplant recipients. The patients at highest risk of developing CMV disease are seronegative recipients of seropositive donors, and seropositive recipients who receive antilymphocyte agents such as OKT3 and antithymocyte globulin (ATG) for induction or for rejection. There have been many trials of CMV prevention, but they are difficult to compare with one another because of variability in definitions and end points. Two modalities that have been used to prevent CMV disease are prophylaxis and preemptive therapy. In prophylaxis all patients are given an antiviral agent in order to prevent CMV disease, while in preemptive therapy (also called targeted prophylaxis) only patients who are identified as 'high risk' are selected for treatment. Selected trials of prophylaxis and preemptive therapy in solid-organ recipients are reviewed. The factors to be considered in using one modality or the other are side effects from antivirals, cost of monitoring and antivirals, efficacy of the two modalities, and potential emergence of drug resistance. Sensitive tests that have been used for early diagnosis and monitoring of CMV are antigenemia and the polymerase chain reaction (PCR). Antigen pp65 is a lower matrix protein and can be detected in peripheral blood leukocytes. The sensitivity and specificity are high and vary from 89% to 100% and 92% to 96%, respectively. Currently, many authors believe that the antigenemia test is more useful than the PCR test. The antigenemia test is useful for viral monitoring as a guide for preemptive therapy after organ transplantation. Persistence of high counts of antigenemia may indicate inadequate antiviral therapy or emergence of resistance. Recurrence of positive antigenemia after treatment of CMV disease can be a sign of relapse. Transplant patients who develop resistance to antiviral drugs are usually seronegative recipients who receive an organ from a seropositive donor and have several courses of antivirals for CMV disease. Ganciclovir is the most frequent antiviral agent used in transplant recipients and is usually well tolerated. Resistance to ganciclovir may occur and is usually secondary to virus mutation in the UL97 gene. The availability of sensitive diagnostic tests such as pp65 antigenemia has made the early diagnosis of CMV possible in organ transplant recipients. CMV is being treated much earlier now, and progression to disseminated disease is uncommon. Prudent use of antiviral drugs will hopefully limit the problem of drug resistance.

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“…0,01 0,1 1 10 100 1.000 Bailey et al 1993Boland et al 1993Bordigoni et al 1987Bowden et al 1986Bowden et al 1991Cofer et al 1991Condie et al 1984Fehir et al 1989Feinstein et al 1999Greger et al 1986Grundmann et al 1987Kasiske et al 1989Metselaar et al 1989Meyers et al 1983Peraldi et al 1996Ringden et al 1987Rostaing et al 1997Ruutu et al 1997Saliba et al 1989Snydman et al 1987Snydman et al 1993Steinmüller et al 1990Stippel et al 1991Sullivane et al 1990Winston et al 1982Winston et al 1987Winston et al 1993 all studies Generell sind die Ergebnisse unter CMVIG Prophylaxe besser als unter IVIG Prophylaxe. Dies gilt insbesondere für CMV-Erkrankung aber auch für die Mortalität.…”

Section: Metaanalyseunclassified

Immunglobuline in der Transplantationsmedizin - Pr�vention und Therapie von Cytomegalievirus-Infektionen

Jonas¹,

Schmetterer²,

Sycha³

et al. 2012

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Prevention of Cytomegalovirus-Related Death by Passive Immunization

Cited by 49 publications

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CMV‐hyperimmune globulin for preventing cytomegalovirus infection and disease in solid organ transplant recipients: a meta‐analysis

CMV‐hyperimmune globulin for preventing cytomegalovirus infection and disease in solid organ transplant recipients: a meta‐analysis

Prevention and treatment of cytomegalovirus infection in organ transplant recipients

Immunglobuline in der Transplantationsmedizin - Pr�vention und Therapie von Cytomegalievirus-Infektionen

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