Therapeutic Effect of the Acquisition of Cytomegalovirus-Specific Immune Response During Preemptive Treatment

BenMarzouk-Hidalgo, Omar J.; Cisneros, José Miguel; Cordero, Elisa; Martín-Peña, Almudena; Sánchez, Berta; Martín-Gandul, Cecilia; Gentil, M.A.; Bravo, Miguel Ángel Gómez; Lage, E.; Pérez‐Romero, Pilar

doi:10.1097/tp.0b013e3182115ba2

Cited by 48 publications

(32 citation statements)

References 32 publications

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“…The authors concluded that baseline immunity and antiviral therapy but not antithymocyte globulin treatments profoundly influence T-cell reconstitution in kidney transplant recipients. Another study of 21 subjects on preemptive therapy after SOT, who developed CMV replication episodes at a median of 4 weeks (range 2-8 weeks) after transplantation and a CMV-specific T-cell response (as determined by CMV-specific T-cell intracellular cytokine Kotton staining) at a median of 12 weeks (range 10-20 weeks), experienced a decline in the incidence of CMV replication episodes that was inversely correlated with the acquisition of the CMV-specific T-cell response (42). In addition, after acquisition of the immune response, 42 CMV replication episodes were cleared without treatment.…”

Section: Vaccines and Tailored Prevention Based On Immunology: The Wamentioning

confidence: 99%

CMV: Prevention, Diagnosis and Therapy

Kotton

2013

American Journal of Transplantation

243

218

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Cytomegalovirus (CMV) is the most common infection after organ transplantation and has a major impact on morbidity, mortality and graft survival. Optimal prevention, diagnosis and treatment of active CMV infection enhance transplant outcomes, and are the focus of this section. Methods to prevent CMV include universal prophylaxis and preemptive therapy; each has its merits, and will be compared and contrasted. Diagnostics have improved substantially in recent years, both in type and quality, allowing for more accurate and savvy treatment; advances in diagnostics include the development of an international standard, which should allow comparison of results across different methodologies, and assays for cellular immune function against CMV. Therapy primarily involves ganciclovir, now rendered more versatile by data suggesting oral therapy with valganciclovir is not inferior to intravenous therapy with ganciclovir. Treatment of resistant virus remains problematic, but is enhanced by the availability of multiple novel therapeutic agents.

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Section: Vaccines and Tailored Prevention Based On Immunology: The Wamentioning

confidence: 99%

CMV: Prevention, Diagnosis and Therapy

Kotton

2013

American Journal of Transplantation

243

218

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“…However, Dþ/RÀ patients were not included (14) or represented only a minority of all patients included in these trials (10,11). Some studies showed a marked benefit of the preemptive approach in Dþ/RÀ patients (28,29), although recent studies have shown a similar or even higher incidence of CMV diseases compared to the use of antiviral prophylaxis (9,30). In a French study, 80 Dþ/RÀ kidney transplant recipients followed preemptively were compared to a historical cohort of 32 Dþ/RÀ patients who received antiviral prophylaxis (30).…”

Section: Impact Of CMV Preventionmentioning

confidence: 99%

Impact of Antiviral Preventive Strategies on the Incidence and Outcomes of Cytomegalovirus Disease in Solid Organ Transplant Recipients

Manuel

Kralidis

Mueller

et al. 2013

American Journal of Transplantation

100

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We assessed the impact of antiviral prophylaxis and preemptive therapy on the incidence and outcomes of cytomegalovirus (CMV) disease in a nationwide prospective cohort of solid organ transplant recipients.Risk factors associated with CMV disease and graft failure-free survival were analyzed using Cox regression models. One thousand two hundred thirty-nine patients transplanted from May 2008 until March 2011 were included; 466 (38%) patients received CMV prophylaxis and 522 (42%) patients were managed preemptively. Overall incidence of CMV disease was 6.05% and was linked to CMV serostatus (Dþ/RÀ vs. Rþ, hazard ratio [HR] 5.36 [95% CI 3.14-9.14], p < 0.001). No difference in the incidence of CMV disease was observed in patients receiving antiviral prophylaxis as compared to the preemptive approach (HR 1.16 [95% CI 0.63-2.17], p ¼ 0.63). CMV disease was not associated with a lower graft failure-free survival (HR 1.27 [95% CI 0.64-2.53], p ¼ 0.50). Nevertheless, patients followed by the preemptive approach had an inferior graft failure-free survival after a median of 1.05 years of follow-up (HR 1.63 [95% CI 1.01-2.64], p ¼ 0.044). The incidence of CMV disease in this cohort was low and not influenced by the preventive strategy used. However, patients on CMV prophylaxis were more likely to be free from graft failure.

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“…26 Preemptive therapy may have a beneficial effect on the acquisition of a CMV-specific immune response. 27 Therefore, prophylaxis is associated with late-onset disease, and preemptive therapy may be protective against late-onset disease. 28 No late-onset CMV disease occurred in the present study.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2014

Exp Clin Transplant

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Objectives: Cytomegalovirus is the most common viral infection after orthotopic liver transplant. The purpose of the present study was to determine the incidence of cytomegalovirus reactivation in Iranian liver transplant recipients at our center and to evaluate outcomes with preemptive therapy with ganciclovir for pp65 antigenemia. Materials and Methods: There were 145 patients who had liver transplant and who survived > 2 weeks after transplant. All patients were evaluated for pp65 antigenemia weekly until 90 days after transplant. The diagnosis of cytomegalovirus reactivation was made when a recipient had pp65 antigenemia ≥ 1/50 000 leukocytes. In patients who had cytomegalovirus infection, preemptive therapy with ganciclovir (5 mg/kg, intravenous, twice daily) was started immediately after diagnosis and continued for ≥ 21 days and until cytomegalovirus antigen became undetectable on 2 consecutive tests. Results: All patients in our study were seropositive for cytomegalovirus before transplant. Follow-up at mean 27 ± 20 months (range, 5.2 to 80.6 mo) after transplant showed that 46 patients (32%) had cytomegalovirus reactivation at mean 56 ± 67 days after transplant (range, 12 to 445 d). There was a higher frequency of female patients in the cytomegalovirus reactivation than non-reactivation group (odds ratio, 2.3; P ≤ .02). The most common causes of liver failure in the cytomegalovirus reactivation group were autoimmune hepatitis, cryptogenic cirrhosis, and hepatitis B virus cirrhosis. There was no significant relation between cause of liver failure, use of steroids before or after transplant, and frequency of acute rejection and cytomegalovirus reactivation. Only 1 patient (2%) developed cytomegalovirus disease at 22 days after transplant, and this patient was treated successfully. There were 6 patients (13%) who developed a second episode of cytomegalovirus reactivation at median 43 days (range, 10 to 176 d) after the first episode; all 6 patients were treated successfully with ganciclovir. Conclusions: Preemptive treatment with ganciclovir may be an effective approach against cytomegalovirus in seropositive recipients after liver transplant.

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Therapeutic Effect of the Acquisition of Cytomegalovirus-Specific Immune Response During Preemptive Treatment

Cited by 48 publications

References 32 publications

CMV: Prevention, Diagnosis and Therapy

CMV: Prevention, Diagnosis and Therapy

Impact of Antiviral Preventive Strategies on the Incidence and Outcomes of Cytomegalovirus Disease in Solid Organ Transplant Recipients

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