The current burden of cytomegalovirus infection in kidney transplant recipients receiving no pharmacological prophylaxis

Abstract

the incidence of CMV events was high and associated with higher incidence of acute rejection and changes in immunosuppression. Besides traditional risk factors, renal function at 1 month was independently associated with CMV infection.

Long‐term safety outcome of systemic immunosuppression in pig‐to‐nonhuman primate corneal xenotransplantation

“…Additionally, no clinically symptomatic RhCMV disease was observed, which may be related to the fact that all our NHPs had RhCMV Abs before transplantation. Given that there is no RhCMV disease in the protocol (anti‐CD20/tacrolimus) of our study, this immunosuppressive regimen can be considered as tolerable when compared to the facts that (a) 5.56%‐41.4% of CMV disease rates in kidney allotransplant recipients under a similar triple immunosuppressant regimen, and (b) there is currently no searchable report about reactivation of CMV disease in corneal allotransplant recipients . In high‐risk corneal allotransplantation, systemic cyclosporine, tacrolimus, or mycophenolate mofetil can be administered systemically .…”

“…As far as the authors know, there has been no report of serious pathogen reactivation under immunosuppression from these studies on corneal allotransplantation presumably because most of the studies used one drug (mono‐therapy) . Considering that high dosage of triple combination of immunosuppressants (anti‐CD20 antibody, tacrolimus, basiliximab) is used in corneal xenotransplantation, it would be reasonable to evaluate whether the effect of our triple immunosuppressants regimen on the CMV disease in xenotransplantation is comparable to effect of the other triple immunosuppressants regimen (antithymocyte globulin, tacrolimus with either mycophenolate or azathioprine) or low dosage of the similar triple immunosuppressants regimen (200‐500 mg of anti‐CD20 antibody, either tacrolimus or cyclosporine, basiliximab) in clinical allotransplantation such as kidney transplantation. The frequency of CMV disease occurrence is 41.4% with the former regimen and 5.56% with the latter regimen .…”

“…Considering that high dosage of triple combination of immunosuppressants (anti‐CD20 antibody, tacrolimus, basiliximab) is used in corneal xenotransplantation, it would be reasonable to evaluate whether the effect of our triple immunosuppressants regimen on the CMV disease in xenotransplantation is comparable to effect of the other triple immunosuppressants regimen (antithymocyte globulin, tacrolimus with either mycophenolate or azathioprine) or low dosage of the similar triple immunosuppressants regimen (200‐500 mg of anti‐CD20 antibody, either tacrolimus or cyclosporine, basiliximab) in clinical allotransplantation such as kidney transplantation. The frequency of CMV disease occurrence is 41.4% with the former regimen and 5.56% with the latter regimen . Therefore, with regard to CMV reactivation, our work is novel in that it reveals that the administration of high dosage of anti‐CD20 Ab combined with tacrolimus/basiliximab for xenotransplantation may be comparably safe with the regimens that have been conventionally used in clinical settings for allotransplantation.…”

Cytomegalovirus infection after transplantation: prevention is still the challenge

“…This is the same incidence from another Brazilian cohort, which however did not implement any CMV prevention. 1 It is not clear if the low efficacy of the preventive strategy from Felipe et al 3 was in part due to logistic problems, antigenemia sensitivity or the threshold for treatment. 1 But it seems that the biweekly monitoring was not enough to avoid CMV disease in patients given ATG.…”

“…3 It informs about recent impact of CMV on kidney transplantation. The small proportion of IgG seronegative patients (6%) corroborates that in Brazil the main issue is the recipient of intermediate risk (seropositive).…”