Cytomegalovirus in renal transplant recipients from living donors with and without valganciclovir prophylaxis and with immunosuppression based on anti-thymocyte globulin or basiliximab

Andrade‐Sierra, Jorge; Heredia-Pimentel, Alejandro; Rojas‐Campos, Enrique; Flores, D.; Cerrillos‐Gutiérrez, José Ignacio; Miranda-Díaz, Alejandra Guillermina; Evangelista-Carrillo, Luis Alberto; Martínez-Martínez, Petra; Jalomo-Martínez, Basilio; González-Espinoza, Eduardo; Gómez-Navarro, Benjamín; Medina-Pérez, Miguel; Nieves-Hernández, J.J.

doi:10.1016/j.ijid.2021.04.032

Cited by 9 publications

(7 citation statements)

References 65 publications

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“…Valacyclovir had greater efficacy than acyclovir in preventing CMV infection [ 17 ]. Although there was evidence that a low dose of ATG was associated with lower CMV-free survival than basiliximab [ 18 ], there was no significant difference in the infection rate between the 2 groups in our study. This could be because in our study only 8 patients received ATG as induction therapy, while 64 patients received basiliximab.…”

Section: Discussioncontrasting

confidence: 77%

“…The different outcomes may be due to the use of cyclosporin in other studies and use of tacrolimus in our research. Regarding the maintenance of immunosuppression therapy, we followed the guideline of tacrolimus blood level 7–10 ng/mL and a 1.5–2 g/day dose of MMF [ 18 ]. A higher tacrolimus trough level was reported to be an independent risk factor for BK infection in Chinese and Tunisian renal transplant recipients [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors for Polyomavirus, Cytomegalovirus, and Viruria Co-Infection for Follow-Up of Renal Transplant Patients

Hieu

2022

Ann Transplant

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Background The interaction of viral infection may be associated with increased morbidity after renal transplantation. This study aimed to identify the incidence and risk factors of viruria infections in renal transplant recipients. Material/Methods In this longitudinal study, 502 episodes recorded in 81 kidney transplant patients from 1/2019 to 12/2021 in a hospital in Vietnam were included. BK, JC polyomaviruses, CMV, EBV, and HSV were detected. Multivariable Cox regression analysis was performed to evaluate risk factors for the viruria infection. Results Fifty-six patients (69.1%) had viruria co-infection. The incidence of JC, CMV, and BK infection was the most common viruria, with 67.9%, 61.7%, and 56.8%, respectively. Cox regression revealed that the risk factors for JC were single infection, dose of MMF (HR 1.002), corticoid (HR 1.02), hypertension (HR 1.65), and hematuria (HR 2.03); risk factors for CMV infection were male sex (HR 1.92) and eGFR (HR 0.98); risk factors for BK single infection were hypertension (HR 1.67), proteinuria (HR 3.80), higher tacrolimus trough level (HR 1.17), and dose of MMF (HR 1.002). Hypertension (HR 1.68), fasting plasma glucose (HR 1.13), proteinuria (HR 6.01), tacrolimus trough level (HR 1.12), and dose of MMF (HR 1.004) were independent risk factors for the viruria co-infection. Conclusions Kidney function was associated with the incidence of viruria. Higher tacrolimus trough level and dose of MMF were associated with higher risk of BK, JC, and co-infection.

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Section: Discussioncontrasting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Risk Factors for Polyomavirus, Cytomegalovirus, and Viruria Co-Infection for Follow-Up of Renal Transplant Patients

Hieu

2022

Ann Transplant

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“…The use of certain T-cell depleting agents (ATG, alemtuzumab) (13,15,16) and high doses of immunosuppressive agents have been shown to be associated with increases in the risk of CMV (7). Additionally, younger age (17,18), African American race, use of mammalian target of rapamycin inhibitors (19)(20)(21)(22)(23)(24), and PRA ≥80% (25) are associated with decreased risk of CMV infection, and hence, decreased need for CMV prophylaxis. There is some evidence that basiliximab is negatively associated with CMV infection and the need for prophylaxis (17,26).…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, younger age (17,18), African American race, use of mammalian target of rapamycin inhibitors (19)(20)(21)(22)(23)(24), and PRA ≥80% (25) are associated with decreased risk of CMV infection, and hence, decreased need for CMV prophylaxis. There is some evidence that basiliximab is negatively associated with CMV infection and the need for prophylaxis (17,26). Our findings were mostly consistent in this regard.…”

Section: Discussionmentioning

confidence: 99%

Real-World Treatment Patterns of Antiviral Prophylaxis for Cytomegalovirus Among Adult Kidney Transplant Recipients: A Linked USRDS-Medicare Database Study

Raval

Ganz²,

Fraeman³

et al. 2022

Transpl Int

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Limited data exist on cytomegalovirus (CMV) antiviral treatment patterns among kidney transplant recipients (KTRs). Using United States Renal Database System registry data and Medicare claims (1 January 2011–31 December 2017), we examined CMV antiviral use in 22,878 KTRs who received their first KT from 2011 to 2016. Three-quarters of KTRs started CMV prophylaxis (85.8% of high-, 82.4% of intermediate-, and 32.1% of low-risk KTRs). Median time to prophylaxis discontinuation was 98, 65, and 61 days for high-, intermediate-, and low-risk KTRs, respectively. Factors associated with receiving CMV prophylaxis were high-risk status, diabetes, receipt of a well-functioning kidney graft, greater time on dialysis before KT, panel reactive antibodies ≥80%, and use of antithymocyte globulin, alemtuzumab, and tacrolimus. KTRs were more likely to discontinue CMV prophylaxis if they developed leukopenia/neutropenia, had cardiovascular disease, or received their kidney from a deceased donor. These findings suggest that adherence to the recommended duration of CMV-prophylaxis for high and intermediate-risk patients is suboptimal, and CMV prophylaxis is overused in low-risk patients.

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“…HCMV infection is one of the major causes of mortality and morbidity in renal-transplant recipients [5]. The Behnezhad/Parhizgari/Shafiei-Jandaghi/ Yavarian/Mokhtari-Azad Intervirology 2023;66:1-7 2 DOI: 10.1159/000526095 infection of HCMV varies from 17.8% to 63.2% in renaltransplant recipients [6]. The highest risk for HCMV infection in renal-transplant recipients happens when the donor is seropositive and the recipient is seronegative.…”

Section: Introductionmentioning

confidence: 99%

Molecular Detection and Genotyping of Human Cytomegalovirus in Kidney Transplant Recipients under Ganciclovir Prophylaxis in Iran

et al. 2022

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Introduction: Human Cytomegalovirus (HCMV) infection is one of the most common viral complications in kidney transplant recipients. Although there are effective treatments strategies for the HCMV infection, this infection is still one of the causes of kidney transplant rejection. Methods: A total of 246 kidney transplant recipients participated in this cross-sectional study. Viral DNA was extracted from these plasma samples and the presence of HCMV genome was determined by Semi-nested PCR with specific primers for HCMV B glycoprotein gene. Sanger sequencing analyses were carried out to determine HCMV genotypes and Mega x software was used for nucleotide alignment and construction of a phylogenetic tree. Results: Human cytomegalovirus DNA was detected in 11 (4.47%) recipients. According to the phylogenetic analysis, HCMV gB3 was 50% among kidney transplant recipients, followed by gB4 30% and gB1 20% however, the gB2 genotype was not detected. Conclusions: This study demonstrated that the HCMV infection in our patients is relatively low because all transplant recipients received appropriate prophylaxis, thereby antiviral prophylaxis is recommended for all patients at risk of HCMV infection after kidney transplantation. Also, gB3 was the most predominant genotype among our kidney transplant recipients that was related to the higher rate of prevalence of severe HCMV infections. Moreover, elevated serum creatinine level was detected in patients at the time of detection of HCMV infection.

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Cytomegalovirus in renal transplant recipients from living donors with and without valganciclovir prophylaxis and with immunosuppression based on anti-thymocyte globulin or basiliximab

Cited by 9 publications

References 65 publications

Risk Factors for Polyomavirus, Cytomegalovirus, and Viruria Co-Infection for Follow-Up of Renal Transplant Patients

Risk Factors for Polyomavirus, Cytomegalovirus, and Viruria Co-Infection for Follow-Up of Renal Transplant Patients

Real-World Treatment Patterns of Antiviral Prophylaxis for Cytomegalovirus Among Adult Kidney Transplant Recipients: A Linked USRDS-Medicare Database Study

Molecular Detection and Genotyping of Human Cytomegalovirus in Kidney Transplant Recipients under Ganciclovir Prophylaxis in Iran

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