Prophylaxis of Primary Cytomegalovirus Disease in Renal Transplant Recipients

Conti, David; Freed, Brian M.; Gruber, Scott A.; Lempert, Neil

doi:10.1001/archsurg.1994.01420280121016

Cited by 57 publications

(45 citation statements)

References 14 publications

(3 reference statements)

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“…In organ transplant recipients, primary infection with Epstein-Barr virus and cytomegalovirus is considered to be more severe than reactivation infection (8,9,48,49,53). Experience with BKV infection in kidney transplant recipients is conflicting.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Analysis of Levels of Immunoglobulins against BK Virus Capsid Proteins in Kidney Transplant Recipients

Randhawa

Bohl

Brennan

et al. 2008

Clin Vaccine Immunol

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This study sought to evaluate serology and PCR as tools for measuring BK virus (BKV) replication. Levels of immunoglobulin G (IgG), IgM, and IgA against BKV capsids were measured at five time points for 535 serial samples from 107 patients by using a virus-like particle-based enzyme-linked immunosorbent assay. Viral DNA in urine and plasma samples was quantitated. The seroconversion rate was 87.5% (14/16); 78.6% (11/14) and 14.3% (2/14) of patients who seroconverted developed viruria and viremia, respectively. Transient seroreversion was observed in 18.7% of patients at 17.4 ؎ 11.9 weeks posttransplant and was not attributable to loss of antigenic stimulation, changes in immunosuppression, or antiviral treatment. Titers for anti-BK IgG, IgA, and IgM were higher in patients with BKV replication than in those without BKV replication. A rise in the optical density (OD) of anti-BK IgA (0.19), IgM (0.04), or IgG (0.38) had a sensitivity of 76.6 to 88.0% and a specificity of 71.7 to 76.1% for detection of viruria. An anti-BK IgG-and IgA-positive phenotype at week 1 was less frequent in patients who subsequently developed viremia (14.3%) than in those who subsequently developed viruria (42.2%) (P ‫؍‬ 0.04). Anti-BK IgG OD at week 1 showed a weak negative correlation with peak urine viral load (r ‫؍‬ ؊0.25; P ‫؍‬ 0.05). In summary, serial measurements of anti-BKV immunoglobulin class (i) detect onset of viral replication, (ii) document episodes of seroreversion, and (iii) can potentially provide prognostic information.

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Section: Discussionmentioning

confidence: 99%

Longitudinal Analysis of Levels of Immunoglobulins against BK Virus Capsid Proteins in Kidney Transplant Recipients

Randhawa

Bohl

Brennan

et al. 2008

Clin Vaccine Immunol

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“…Soon thereafter, it was shown that efficacy of antiviral prophylaxis was equal to seroprophylaxis in CMV high-risk patients after kidney transplantation and that this therapy was much cheaper than the use of CMV-specific hyperimmune globulin [16].…”

Section: Antiviral Prophylaxismentioning

confidence: 99%

Cytomegalovirus post kidney transplantation: prophylaxis versus pre-emptive therapy?

2015

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SummaryCytomegalovirus is the most important pathogen causing opportunistic infections in kidney allograft recipients. The occurrence of CMV disease is associated with higher morbidity, higher incidence of other opportunistic infections, allograft loss and death. Therefore, an efficient strategy to prevent CMV disease after kidney transplantation is required. Two options are currently available: pre-emptive therapy based on regular CMV PCR monitoring and generalized antiviral prophylaxis during a defined period. In this review, we describe those two approaches, highlight the distinct advantages and risks of each strategy and summarize the four randomized controlled trials performed in this field so far. Taken this evidence together, pre-emptive therapy and anti-CMV prophylaxis are both equally potent in preventing CMV-associated complications; however, the pre-emptive approach may have distinct advantages in allowing for development of long-term anti-CMV immunity. We propose a risk-adapted use of these approaches based on serostatus, immunosuppressive therapy and availability of resources at a particular transplant centre. Cytomegalovirus in kidney transplantationGeneral introduction Cytomegalovirus (CMV) is the most important viral pathogen and the most prevalent opportunistic infection after kidney transplantation [1]. Infection occurs by three ways (in order of incidence): (i) endogenous reactivation of CMV in the recipient, (ii) donor-derived infection transmitted by the allograft and (iii) de novo infection acquired from the general population. From a clinical point of view, three distinctive presentations can occur: asymptomatic viraemia, CMV viral syndrome (with fever, malaise and leukopenia) and CMV tissue invasive disease (with documented end-organ damage in histology or imaging such as colitis, hepatitis, pneumonitis or retinitis).Apart from CMV viral syndrome and tissue invasive disease, a number of indirect immunomodulatory effects of CMV have been postulated [2], thereby increasing the incidence of acute and chronic rejection after solid organ transplantation on one side (probably via a bystander activation of alloreactive T cells during an antiviral response of the host), but also the incidence of other opportunistic infections on the other side. Immunity against CMVThe incidence of CMV infection and serious clinical complications is highly dependent on the serostatus (presence of CMV-specific antibodies) of recipient (R) and donor (D) with the constellation D+RÀ bearing the highest risk, followed by D+R+, DÀR+ and DÀRÀ. Studies on anti-CMV strategies usually distinguish between these risk categories, thereby often summarizing the D+R+ and DÀR+ groups in an intermediate-risk category [3]. The DÀRÀ recipients as ©

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“…Human immunoglobulin preparations have been studied as prophylactic agents against CMV infection after organ transplantation (21,75,130,174,222,395,(431)(432)(433) (Table 4). Standard immunoglobulin preparations contain antibodies from blood and plasma of donors with natural antibodies against CMV, and they vary in their content of neutralizing antibody titers against CMV.…”

Section: Immunoglobulin Prophylaxismentioning

confidence: 99%

“…vir both reduce symptomatic CMV infection but that the latter is a much cheaper option (75). Together, the results of randomized trials with solid-organ transplant indicate that (i) immunoglobulin preparations confer some degree of efficacy in preventing CMV disease, this being more consistent with CMV hyperimmune globulin preparations; (ii) these benefits are attenuated when antilymphocyte therapy is used; (iii) renal transplant recipients are more likely to benefit from CMV hyperimmune globulin than are nonrenal (e.g., liver) transplant recipients, especially within the high-risk (CMV donor positive-recipient negative) group; and (iv) the advantages include the relatively infrequent administration (weekly intervals) and the lack of need for continuous intravenous access.…”

Section: Vol 13 2000 CMV Infection In Transplant Recipients 99mentioning

confidence: 99%

New Strategies for Prevention and Therapy of Cytomegalovirus Infection and Disease in Solid-Organ Transplant Recipients

Sia¹,

Patel²

2000

Clinical Microbiology Reviews

220

181

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Prophylaxis of Primary Cytomegalovirus Disease in Renal Transplant Recipients

Abstract: These data suggest that prophylactic ganciclovir therapy provides a cost-effective approach toward significantly improving the outcome of renal transplantation in recipients at risk for primary CMV disease.

Cited by 57 publications

References 14 publications

Longitudinal Analysis of Levels of Immunoglobulins against BK Virus Capsid Proteins in Kidney Transplant Recipients

Longitudinal Analysis of Levels of Immunoglobulins against BK Virus Capsid Proteins in Kidney Transplant Recipients

Cytomegalovirus post kidney transplantation: prophylaxis versus pre-emptive therapy?

New Strategies for Prevention and Therapy of Cytomegalovirus Infection and Disease in Solid-Organ Transplant Recipients

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