The Association of Cytomegalovirus Sero-Pairing with Outcomes and Costs Following Cadaveric Renal Transplantation Prior to the Introduction of Oral Ganciclovir CMV Prophylaxis

Schnitzler, Mark A.; Lowell, Jeffrey A.; Hardinger, Karen L.; Boxerman, Stuart B.; Bailey, Thomas C.; Brennan, Daniel C.

doi:10.1034/j.1600-6143.2003.00069.x

Cited by 70 publications

(54 citation statements)

References 29 publications

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“…In one study, adding OKT3 treatment as induction therapy raised the incidence of CMV disease from 21% to 59% [23]. USRDS data have shown that recipients of CMV seropositive kidneys who do not receive prophylaxis have increased rates of CMV disease, allograft loss, and healthcare costs [12]. A recent Cochrane review found that prophylaxis for high risk patients reduces CMV infection, disease, and mortality in solidorgan transplant recipients by 39%, 58% and 37%, respectively [13].…”

Section: Discussionmentioning

confidence: 99%

A Case of Cytomegalovirus-Induced Arthritis after Lymphocyte-Depleting Therapy for Kidney Allograft Rejection

Fuquay¹,

Cooper²

2012

OJNeph

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Cytomegalovirus viremia and tissue-invasive disease are common after kidney transplantation. Chemoprophylaxis has made substantial improvement in this clinical problem. Here we report a 29-year-old woman who had kidney allograft rejection and received lymphocyte-depleting therapy. She presented with a new oligo-arthritis that led to 2 successive arthrocenteses. The etiology of the inflammation could not be determined initially. On the second arthrocentesis, a synovial fluid cytomegalovirus polymerase chain reaction test was positive. The patient responded to treatment with valganciclovir, had negative follow-up serum cytomegalovirus polymerase chain reaction tests, and experienced resolution of her joint inflammation. We review briefly the data for cytomegalovirus chemoprophylaxis, preemptive screening, and treatment recommendations.

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Section: Discussionmentioning

confidence: 99%

A Case of Cytomegalovirus-Induced Arthritis after Lymphocyte-Depleting Therapy for Kidney Allograft Rejection

Fuquay¹,

Cooper²

2012

OJNeph

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“…The risk of CMV infection/reactivation is highest when the allograft donor (D) is serologically positive (+) and the recipient (R) is serologically negative (−). Intermediate risk occurs in the case of D+/R+, or D−/R+ [9][10][11]. In D+ patients HCMV genetic material has been detected in the vasculature of the transplanted organ demonstrating that the allograft may be an important source of virus [12].…”

Section: Association Of Human Cytomegalovirus Infections With Increasmentioning

confidence: 99%

Acceleration of allograft failure by cytomegalovirus

Streblow

Orloff

Nelson

2007

Current Opinion in Immunology

122

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SummaryA number of human herpes viruses are important opportunistic pathogens that have been associated with increased morbidity and mortality in transplant recipients including human cytomegalovirus (HCMV), HHV6, HHV7, HHV8 as well as HSV-1, VZV. However, HCMV has been linked both epidemiologically and through the use of animal models to the acceleration of acute and chronic allograft rejection. This review will cover the pathophysiology, epidemiology and mechanisms of CMV-associated disease in the setting of transplantation.

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“…[4][5][6] The risk of CMV infection after transplant is highly dependent on donor (D) and recipient (R) serostatus and the intensity of the immunosuppression regimen. 1,[7][8][9] Cytomegalovirus-seronegative recipients of CMV-seropositive donors (D+/R−) are at the highest risk, whereas D+/R+ or D−/R+ transplants are at moderate risk. [7][8][9] Valganciclovir has an extended prophylactic effect against other viruses that also require prophylaxis (eg, herpes simplex and varicella-zoster virus infections).…”

Section: Introductionmentioning

confidence: 99%

“…1,[7][8][9] Cytomegalovirus-seronegative recipients of CMV-seropositive donors (D+/R−) are at the highest risk, whereas D+/R+ or D−/R+ transplants are at moderate risk. [7][8][9] Valganciclovir has an extended prophylactic effect against other viruses that also require prophylaxis (eg, herpes simplex and varicella-zoster virus infections). 1 At our center, most kidney transplant recipients are at moderate risk for CMV infection and they receive universal prophylaxis due to its ease of administration, effectiveness, and prophylaxis against other viruses and possibly other bacterial and protozoan infections.…”

Section: Introductionmentioning

confidence: 99%

“…1 At our center, most kidney transplant recipients are at moderate risk for CMV infection and they receive universal prophylaxis due to its ease of administration, effectiveness, and prophylaxis against other viruses and possibly other bacterial and protozoan infections. [6][7][8][9][10][11][12] Valganciclovir is a valine ester prodrug of ganciclovir that was developed to overcome the limitations of oral and intravenous ganciclovir. [10][11][12] A single daily 900-mg oral dose provides comparable plasma ganciclovir exposures to those achieved with 5 mg/kg intravenous ganciclovir.…”

Section: Introductionmentioning

confidence: 99%

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Halim

Al-Otaibi²,

Gheith³

et al. 2016

Exp Clin Transplant

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Objectives: Prophylaxis for cytomegalovirus infection is highly recommended for kidney transplant recipients. The use of daily 900 mg valganciclovir is the usual prophylactic dose, whereas 450 mg daily is under investigation. We evaluated the outcome of using 2 different doses of valganciclovir prophylaxis for cytomegalovirus infection after kidney transplant. Materials and Methods: We randomized kidney transplant recipients (1:1) to receive 450 mg daily valganciclovir (group 1) or 900 mg daily valganciclovir (group 2) for the first 6 months after kidney transplant. Serologically, all patients were at moderate risk for cytomegalovirus infection. Patients were studied for incidence of cytomegalovirus disease, leukopenia attacks, rejection episodes, and graft outcomes for 1 year. Results: Demographic features of group 1 (98 patients) and group 2 (98 patients) were comparable. More than 50% of patients received thymoglobulin induction therapy without difference between the groups. There were more leukopenia attacks in group 2 (P = .03) requiring higher doses of granulocyte colonystimulating factor (P = .03). Group 2 patients received lower doses of mycophenolate mofetil (P= .04) and required reduced doses of valganciclovir (P = .045). Compared with group 1, the high-dose group developed numerically more rejection episodes (P = .057) and more cytomegalovirus infections requiring full treatment (P = .17). Graft and patient outcomes were satisfactory in both groups. Conclusion:Six months of low-dose valganciclovir prophylaxis for intermediate-risk kidney transplant recipients was as effective as high-dose valganciclovir with a better safety profile.

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The Association of Cytomegalovirus Sero-Pairing with Outcomes and Costs Following Cadaveric Renal Transplantation Prior to the Introduction of Oral Ganciclovir CMV Prophylaxis

Cited by 70 publications

References 29 publications

A Case of Cytomegalovirus-Induced Arthritis after Lymphocyte-Depleting Therapy for Kidney Allograft Rejection

A Case of Cytomegalovirus-Induced Arthritis after Lymphocyte-Depleting Therapy for Kidney Allograft Rejection

Acceleration of allograft failure by cytomegalovirus

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