Clinical outcomes of valganciclovir prophylaxis in high‐risk (D+/R−) renal transplant recipients experiencing delayed graft function

Abstract

Background Cytomegalovirus (CMV) outcomes with valganciclovir prophylaxis in renal transplant recipients experiencing delayed graft function (DGF) are unclear. Methods This single center, retrospective, cohort study of CMV high‐risk (D+/R− with alemtuzumab induction) deceased donor renal transplant recipients receiving valganciclovir prophylaxis assessed CMV outcomes in patients experiencing DGF (n = 72) versus those with immediate graft function (IGF; n = 66). Results Cytomegalovirus viremia by 12 months occurred at similar rates in the IGF and DGF groups (30.3% vs 26.4%, respectively, P = 0.71) with 89.7% (35/39) of all cases classified as CMV disease. The median time to CMV viremia post transplant was day 141 and 138 in the IGF and DGF groups, respectively (P = 0.30). The incidence of biopsy‐proven acute rejection (BPAR) was higher in the DGF group (18.1% vs 4.6%, P = 0.02) with BPAR preceding CMV in only 1 patient. There was no significant difference in graft loss (1.5% vs 4.2%, P = 0.62) or patient survival (98.5% vs 95.8%, P = 0.62) at 1 year between the IGF and DGF groups, respectively. Conclusion Valganciclovir prophylaxis in patients experiencing DGF yielded similar CMV outcomes up to 1‐year post transplant when compared to use in patients with IGF.

Delayed Graft Function Among Kidney Transplant Recipients Is Associated With an Increased Risk of Urinary Tract Infection and BK Viremia

“…39 Similar to our study, Freedman et al 40 found no statistically significant association between CMV and DGF when looking specifically at the CMV high-risk population. 40 Finally, in contrast to our study, assessing risk for DGF and pneumonia, a few studies reported an increased risk of pneumonia among recipients with DGF. [41][42][43] This study has the expected limitations of a single-center observational study, reflecting our specific population and clinical approach.…”

Delayed graft function and rejection are risk factors for cytomegalovirus breakthrough infection in kidney transplant recipients

“…The data in this article are in line with a study by Khurana et al who found that transplant recipients receiving prophylaxis in dosages adjusted for eGFR are at an increased hazard of subsequent CMV prophylaxis breakthrough infections [12]. Freedman et al found 15/138 (11%) breakthrough CMV infections, of which more than half (11/15) were related to underdosing of valganciclovir [13]. In this study DGF was not identified as a risk factor for CMV breakthrough.…”

Efficacy and safety of conventional antiviral agents in preventive strategies for cytomegalovirus infection after kidney transplantation: a systematic review and network meta‐analysis

“…The paramount adverse impact on CMV infection after KT is considered as a potential harm factor for acute allograft rejection [ 74 , 75 ]. CMV can indirectly cause dysregulation in the immune system by increasing the amount of inflammatory cytokine which could augment the immune response, which would accelerate the collagen synthesis in allograft and might participate in the risk of renal acute graft rejection [ 76 , 77 ]. Therefore, anti‐CMV prophylaxis is a new challenge associated with the protection of acute allograft dysfunction after KT.…”