Prospective randomized trial of efficacy of ganciclovir versus that of anti-cytomegalovirus (CMV) immunoglobulin to prevent CMV disease in CMV-seropositive heart transplant recipients treated with OKT3

Aguado, José María; Gómez-Sánchez, Miguel Ángel; Lumbreras, Carlos; Delgado, Juan Marcelo; Lizasoaín, Manuel; Otero, Joaquín R.; Rufilanchas, Juan J.; Noriega, A. R.

doi:10.1128/aac.39.7.1643

Cited by 38 publications

(15 citation statements)

References 5 publications

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“…Over the last decade, three different chemotherapy approaches have been used to cure or prevent HCMV disease in heart (HTR) and lung (LTR) transplant recipients: i) symptomatic or deferred therapy, starting treatment upon appearance of clinical symptoms (2,3); ii) prophylaxis, administering antiviral treatment to all patients after transplantation (4,5); iii) preemptive or targeted therapy, which is given to patients at high risk of developing HCMV disease (6,7).…”

Section: Tomation and Objectivity Of Test Results) And Disadvantages mentioning

confidence: 99%

Human cytomegalovirus pp67 mRNAemia versus pp65 antigenemia for guiding preemptive therapy in heart and lung transplant recipients: a prospective, randomized, controlled, open-label trial1

Gerna¹,

Baldanti

Lilleri

et al. 2003

Transplantation

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Section: Tomation and Objectivity Of Test Results) And Disadvantages mentioning

confidence: 99%

Human cytomegalovirus pp67 mRNAemia versus pp65 antigenemia for guiding preemptive therapy in heart and lung transplant recipients: a prospective, randomized, controlled, open-label trial1

Gerna¹,

Baldanti

Lilleri

et al. 2003

Transplantation

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“…Current prophylactic approaches vary widely among different transplant programs (5,8,18,26,72,104,105,143,145,172,232,236,273,284,299,319,382,396,423,497) (Table 5). Reasons for the discrepancies reflect the absence of large, multicenter, randomized trials evaluating the efficacy of countless preventive strategies.…”

Section: Specific Antiviral Prophylaxismentioning

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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“…A 2‐week course of targeted prophylaxis with ganciclovir was compared with CMV immune globulin in a trial using OKT3 with induction in seropositive heart recipients. The incidence of tissue‐invasive CMV disease was reduced in the ganciclovir arm (6% vs. 40%, P =0.03) ( 51).…”

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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Prospective randomized trial of efficacy of ganciclovir versus that of anti-cytomegalovirus (CMV) immunoglobulin to prevent CMV disease in CMV-seropositive heart transplant recipients treated with OKT3

Cited by 38 publications

References 5 publications

Human cytomegalovirus pp67 mRNAemia versus pp65 antigenemia for guiding preemptive therapy in heart and lung transplant recipients: a prospective, randomized, controlled, open-label trial1

Human cytomegalovirus pp67 mRNAemia versus pp65 antigenemia for guiding preemptive therapy in heart and lung transplant recipients: a prospective, randomized, controlled, open-label trial1

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

Prevention and treatment of cytomegalovirus infection in organ transplant recipients

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