Benefits of Cytomegalovirus Prophylaxis in Solid Organ Transplantation

Pescovitz, Mark D.

doi:10.1097/01.tp.0000230459.22968.26

Cited by 49 publications

(31 citation statements)

References 15 publications

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“…The finding that CMV D+R- recipients fared better was a surprise finding of the study and is largely unexplained. Most studies show that these recipients are at increased risk of both death and graft loss [17]. All patients would have received prophylaxis at both centers.…”

Section: Discussionmentioning

confidence: 99%

Kidney transplant survival in pediatric and young adults

2011

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BackgroundThere is a perception that kidney transplant recipients transferred from pediatric centers to adult care have an increased risk of graft loss. It is not clear whether young adults transplanted in adult centers also suffer from high graft loss rates.MethodsWe examined death censored graft survival in 3 cohorts of young patients transplanted at a single center. Pediatric (PED) patients transplanted at the pediatric center were compared to a cohort of young adults (YAD; age 18- < 25) and a cohort of adults (ADL; age 25-35).ResultsIn a multivariate Cox model for death-censored graft survival, PED survival was statistically similar to the YAD (HR 0.86, 95% CI 0.44, 1.7, p = 0.66), however the ADL cohort (HR 0.45, 95% CI 0.25, 0.82, p = 0.009) demonstrated better survival. Admitted non-adherence rates were not different among cohorts. Patients were transferred within a narrow age window (18.6 ± 1.0 age in years) but at a wide range of times from the date of transplantation (5.1 ± 3.5 years) and with a wide range of graft function (serum creatinine 182 ± 81 μmol/L).ConclusionsThe perception that pediatric transfers do poorly reflects advanced graft dysfunction in some at the time of transfer. The evidence also suggests that it is not the transfer of care that is the critical issue but rather recipients, somewhere between the ages of 11-14 and 25, are a unique and vulnerable cohort. Effective strategies to improve outcomes across this age group need to be identified and applied consistently.

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Section: Discussionmentioning

confidence: 99%

Kidney transplant survival in pediatric and young adults

2011

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“…Although these 'radical' cases have brought significant attention to the transplant community and the public due to the intense media coverage, one must bear in mind that still by far more organ recipients die from consequences associated with the transmission of cytomegalovirus and EBV than all other viruses together. For many viruses reliable prophylaxis is now available and if appropriate allocation is performed these grafts have a good chance for long-term survival [132,[134][135][136]. This knowledge should be considered and in order to optimize the utilization and survival of viral infected grafts, one may consider overriding the Model for End-stage Liver Disease (MELD) allocation system in some cases.…”

Section: Resultsmentioning

confidence: 99%

Transmission of viral disease to the recipient through the donor liver

Bonatti

Sawyer

Dickson

et al. 2007

Current Opinion in Organ Transplantation

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“…In Turkey, results in terms of renal function and BPAR were consistently better in all four treatment groups compared with that in the overall study population, probably in part because fewer patients were infected with CMV; some studies have demonstrated a link between CMV infection and acute rejection [10]. In the interpretation of these figures, one should take into account that the definition of CMV infection was left to the discretion of the investigators and may have varied among countries.…”

Section: Discussionmentioning

confidence: 98%

Low toxicity regimens in renal transplantation: a country subset analysis of the Symphony study

Demirbaş

Hugo

Grinyó

et al. 2009

Transplant International

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Summary Regional transplant practices may affect clinical outcomes within multinational studies. This study evaluated whether the overall results from the Symphony study can be generalized to the participating countries. De novo adult renal transplant recipients (n = 1645) were randomized to receive standard‐dose cyclosporine, or daclizumab induction plus low‐dose cyclosporine, low‐dose tacrolimus, or low‐dose sirolimus, all in addition to mycophenolate mofetil and steroids. Data for the highest patient‐recruiting countries, Spain (n = 275), Germany (n = 316) and Turkey (n = 258), were compared. Patient transplant characteristics were different among the country subsets; only deceased donors in Spain, more expanded criteria donors in Germany, and mainly living donors in Turkey. Efficacy results for the three countries were consistent with that of the overall study – renal function and biopsy‐proven acute rejection (BPAR) rates were superior with low‐dose tacrolimus. Turkey had higher mean calculated glomerular filtration rate across all treatment groups (60.6–72.2 ml/min) compared with that of Spain (51.1–57.5 ml/min) and Germany (51.3–62.9 ml/min). Spain and Turkey had lower BPAR rates across the four treatment groups compared with the overall study; Germany had much higher rates (21.0–54.2%). These findings confirm the general applicability of the Symphony study results and highlight the importance of inclusion of patients from different geographic origins in randomized clinical trials.

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Benefits of Cytomegalovirus Prophylaxis in Solid Organ Transplantation

Cited by 49 publications

References 15 publications

Kidney transplant survival in pediatric and young adults

Kidney transplant survival in pediatric and young adults

Transmission of viral disease to the recipient through the donor liver

Low toxicity regimens in renal transplantation: a country subset analysis of the Symphony study

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