A stringent preemptive protocol reduces cytomegalovirus disease in the first 6 months after kidney transplantation

Greiner, Michael; Cusini, Alexia; Rüesch, Morven; Schiesser, Marc; Ledergerber, Bruno; Fehr, Thomas; Mueller, Nicolas J.

doi:10.1007/s15010-012-0343-5

Cited by 18 publications

(21 citation statements)

References 11 publications

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“…We found a similar incidence rate of CMV disease in KT (4.1/100 person-years) and HCT (5.0/100 person-years) patients during preemptive therapy. Separate previous studies of KT recipients or HCT recipients have reported rates of CMV disease after KT and HCT of 0.8% to 9.0% [7,8,22] and 5.8% [9], respectively. Our findings on the rates of CMV disease in KT and HCT recipients are in line with previous studies.…”

Section: Discussionmentioning

confidence: 99%

Differences of cytomegalovirus diseases between kidney and hematopoietic stem cell transplant recipients during preemptive therapy

Kim

Lee

et al. 2016

Korean J Intern Med

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Background/Aims:Cytomegalovirus (CMV) surveillance and preemptive therapy is a widely-used strategy for preventing CMV disease in transplant recipients. However, there are limited data on the incidence and patterns of CMV disease during the preemptive period. Thus, we investigated the incidence and pattern of tissue-invasive CMV disease in CMV seropositive kidney transplantation (KT) and hematopoietic stem cell transplantation (HCT) recipients during preemptive therapy.Methods:We prospectively identified patients with tissue-invasive CMV disease among 664 KT (90%) and 496 HCT (96%) recipients who were D+/R+ (both donor and recipient seropositive) during a 4-year period.Results:The incidence rates of CMV disease were 4.1/100 person-years (4%, 27/664) in KT recipients and 5.0/100 person-years (4%, 21/496) in HCT recipients. Twenty-six (96%) of the KT recipients with CMV disease had gastrointestinal CMV, whereas 17 (81%) of the HCT recipients had gastrointestinal CMV and 4 (19%) had CMV retinitis. Thus, CMV retinitis was more common among HCT recipients (p = 0.03). All 27 KT recipients with CMV disease suffered abrupt onset of CMV disease before or during preemptive therapy; 10 (48%) of the 21 HCT recipients with CMV disease were also classified in this way but the other 11 (52%) were classified as CMV disease following successful ganciclovir preemptive therapy (p < 0.001).Conclusions:The incidence of CMV disease was about 4% in both KT and HCT recipients during preemptive therapy. However, CMV retinitis and CMV disease as a relapsed infection were more frequently found among HCT recipients.

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Section: Discussionmentioning

confidence: 99%

Differences of cytomegalovirus diseases between kidney and hematopoietic stem cell transplant recipients during preemptive therapy

Kim

Lee

et al. 2016

Korean J Intern Med

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“…This can only be achieved by clear local guidelines and their strict implementation, as recently shown in our centre [26]. 2 Cost: clear statements concerning cost are difficult.…”

Section: A Critical View On Generalized Prophylaxismentioning

confidence: 97%

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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“…& When a preemptive therapy strategy is used, it is recommended that the center develop and validate their local protocol (167). Because preemptive therapy relies on laboratory monitoring, it is important that an appropriate threshold value be chosen for the specific assay that is used.…”

Section: Preemptive Therapy Strategymentioning

confidence: 99%

Updated International Consensus Guidelines on the Management of Cytomegalovirus in Solid-Organ Transplantation

et al. 2013

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Cytomegalovirus (CMV) continues to be one of the most common infections after solid-organ transplantation, resulting in significant morbidity, graft loss, and adverse outcomes. Management of CMV varies considerably among transplant centers but has been become more standardized by publication of consensus guidelines by the Infectious Diseases Section of The Transplantation Society. An international panel of experts was reconvened in October 2012 to revise and expand evidence and expert opinion-based consensus guidelines on CMV management, including diagnostics, immunology, prevention, treatment, drug resistance, and pediatric issues. The following report summarizes the recommendations.

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A stringent preemptive protocol reduces cytomegalovirus disease in the first 6 months after kidney transplantation

Cited by 18 publications

References 11 publications

Differences of cytomegalovirus diseases between kidney and hematopoietic stem cell transplant recipients during preemptive therapy

Differences of cytomegalovirus diseases between kidney and hematopoietic stem cell transplant recipients during preemptive therapy

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

Updated International Consensus Guidelines on the Management of Cytomegalovirus in Solid-Organ Transplantation

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