Cytomegalovirus infection after transplantation: prevention is still the
            challenge

Reusing, José Otto; David‐Neto, Elias

doi:10.5935/0101-2800.20170064

Cited by 2 publications

(4 citation statements)

References 6 publications

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“…According to the best clinical guidelines, both strategies available for preventing the consequences of CMV infection, universal prophylaxis or preemptive treatment, present advantages and some disadvantages, and centers should opt for one or another, considering their characteristics 4 . For example, in Brazil, more than 90% of kidney transplantation is supported by the public health system, and the costs of universal prophylaxis are not disbursed, which can occur in other low and mid-income countries 11 . In the present study, we compared the main CMV-related outcomes when we transitioned from pp65 to RT-PCR in kidney transplant recipients receiving preemptive treatment as a strategy to prevent CMV infection and identified potential clinical predictors of the CMV-related events.…”

Section: Discussionmentioning

confidence: 99%

“…Although universal prophylaxis seems to be associated with lower CMV-related effects, some disadvantages have been highlighted: toxicity, late-onset CMV disease, risk of resistance, and costs 4 . In Brazil, for instance, prophylaxis with oral valganciclovir for 3 months can cost 3 to 7 times more than the preemptive treatment, depending on graft function and frequency of monitoring 11 . Thus, due to the high cost, the way to reduce the impact of CMV involves targeted prevention through preemptive treatment, especially in low and middle-income countries.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Transition from antigenemia to quantitative nucleic acid amplification testing in cytomegalovirus-seropositive kidney transplant recipients receiving preemptive therapy for cytomegalovirus infection

Nakamura

Requião-Moura

Gallo

et al. 2022

Sci Rep

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Due to the high costs, the strategy to reduce the impact of cytomegalovirus (CMV) after kidney transplant (KT) involves preemptive treatment in low and middle-income countries. Thus, this retrospective cohort study compared the performance of antigenemia transitioned to quantitative nucleic acid amplification testing, RT-PCR, in CMV-seropositive KT recipients receiving preemptive treatment as a strategy to prevent CMV infection. Between 2016 and 2018, 363 patients were enrolled and received preemptive treatment based on antigenemia (n = 177) or RT-PCR (n = 186). The primary outcome was CMV disease. Secondarily, the CMV-related events were composed of CMV-infection and disease, which occurred first. There were no differences in 1-year cumulative incidence of CMV-disease (23.7% vs. 19.1%, p = 0.41), CMV-related events (50.8% vs. 44.1%, p = 0.20), neither in time to diagnosis (47.0 vs. 47.0 days) among patients conducted by antigenemia vs. RT-PCR, respectively. The length of CMV first treatment was longer with RT-PCR (20.0 vs. 27.5 days, p < 0.001), while the rate of retreatment was not different (14.7% vs. 11.8%, p = 0.48). In the Cox regression, acute rejection within 30 days was associated with an increased the risk (HR = 2.34; 95% CI = 1.12–4.89; p = 0.024), while each increase of 1 mL/min/1.73 m2 of 30-day eGFR was associated with a 2% reduction risk of CMV-disease (HR = 0.98; 95% CI = 0.97–0.99; p = 0.001). In conclusion, acute rejection and glomerular filtration rate are risk factors for CMV disease, showing comparable performance in the impact of CMV-related events between antigenemia and RT-PCR for preemptive treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Transition from antigenemia to quantitative nucleic acid amplification testing in cytomegalovirus-seropositive kidney transplant recipients receiving preemptive therapy for cytomegalovirus infection

Nakamura

Requião-Moura

Gallo

et al. 2022

Sci Rep

View full text Add to dashboard Cite

show abstract

“…According to the best clinical guidelines, both strategies available for preventing the consequences of CMV infection, universal prophylaxis or preemptive treatment, present advantages and some disadvantages, and centers should opt for one or another, considering their characteristics 4 . For example, in Brazil, more than 90% of kidney transplantation is supported by the public health system, and the costs of universal prophylaxis are not disbursed, which can occur in other low and mid-income countries 11 . In the present study, we compared the main CMV-related outcomes when we transitioned from pp65 to RT-PCR in kidney transplant recipients receiving preemptive treatment as a strategy to prevent CMV infection and identi ed potential clinical predictors of the CMV-related events.…”

Section: Discussionmentioning

confidence: 99%

“…Although universal prophylaxis seems to be associated with lower CMV-related effects, some disadvantages have been highlighted: toxicity, late-onset CMV disease, risk of resistance, and costs 4 . In Brazil, for instance, prophylaxis with oral valganciclovir for three months can cost 3 to 7 times more than the preemptive treatment, depending on graft function and frequency of monitoring 11 . Thus, due to the high cost, the way to reduce the impact of CMV involves targeted prevention through preemptive treatment, especially in low and middle-income countries.…”

Section: Introductionmentioning

confidence: 99%

Transition from Antigenemia to Quantitative Nucleic Acid Amplification Testing in Kidney Transplant Recipients Receiving Preemptive Therapy for Cytomegalovirus Infection.

Nakamura

Requião-Moura

Gallo

et al. 2021

Preprint

View full text Add to dashboard Cite

Due to the high costs, the strategy to reduce the impact of cytomegalovirus (CMV) after kidney transplant (KT) involves preemptive treatment in low and middle-income countries. Thus, this retrospective cohort study compared the performance of antigenemia transitioned to quantitative nucleic acid amplification testing, RT-PCR, in KT recipients receiving preemptive treatment as a strategy to prevent CMV infection. Between 2016 and 2018, 363 patients were enrolled and received preemptive treatment based on antigenemia (n=177) or RT-PCR (n=186). The primary outcome was CMV infection or disease. There were no differences in one-year cumulative incidence of CMV-related events (50.8% vs. 44.1%, P=0.20), neither in time to diagnosis (47.0 vs. 47.0 days) among patients conducted by antigenemia vs. RT-PCR, respectively. The length of CMV first treatment was longer with RT-PCR (20.0 vs. 27.5 days, P<0.001), while the rate of retreatment was not different (14.7% vs. 11.8%, P=0.48). In the Cox regression, the variables associated with CMV-related events were acute rejection within 30 days (HR=2.05, p=0.01) and 30-day glomerular filtration rate (HR=0.98, p<0.001). In conclusion, acute rejection and glomerular filtration rate are risk factors for CMV infection and disease, showing comparable performance in the impact of CMV-related events between antigenemia and RT-PCR for preemptive treatment.

show abstract

Cytomegalovirus infection after transplantation: prevention is still the challenge

Cited by 2 publications

References 6 publications

Transition from antigenemia to quantitative nucleic acid amplification testing in cytomegalovirus-seropositive kidney transplant recipients receiving preemptive therapy for cytomegalovirus infection

Transition from antigenemia to quantitative nucleic acid amplification testing in cytomegalovirus-seropositive kidney transplant recipients receiving preemptive therapy for cytomegalovirus infection

Transition from Antigenemia to Quantitative Nucleic Acid Amplification Testing in Kidney Transplant Recipients Receiving Preemptive Therapy for Cytomegalovirus Infection.

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