Cytomegalovirus Infection Renal Transplant Recipients: Risk Factors and Outcome

Kanter, Julia; Pallardó, Luís; Gavela, Eva; Escudero, Verónica; Beltrán, Sandra; Morales, Alejandra; Ávila, Ana; Crespo, J.F.

doi:10.1016/j.transproceed.2009.06.057

Cited by 47 publications

(53 citation statements)

References 9 publications

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“…Following multivariate analysis, we found that ATG was the only factor associated with CMV disease, whether for LOD or EOD. ATG is a well-known risk factor of CMV disease (6,47), particularly in D+RÀ patients, and, not surprisingly, we also found it was the only risk factor. Interestingly, we found that ATG induction did not hamper Vd2 neg cd T cell expansion following CMV infection, confirming a close observation of the effect of ATG on the development of CMV-specific ab cell T cell response (48).…”

Section: Discussionsupporting

confidence: 76%

Easier Control of Late-Onset Cytomegalovirus Disease Following Universal Prophylaxis Through an Early Antiviral Immune Response in Donor-Positive, Recipient-Negative Kidney Transplants

Kaminski

Couzi

Garrigue³

et al. 2016

American Journal of Transplantation

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Universal prophylaxis for cytomegalovirus (CMV) prevention is viable but, compared with a preemptive strategy, leads to higher incidence of late-onset disease (LOD) associated with poor patient and graft survival. The purpose of this study was to compare LOD with early onset disease (EOD), with a focus on the highest risk kidney transplant recipients (KTRs): CMV seronegative recipients transplanted from seropositive donors (D+RÀ). Since CMV control depends on both antiviral treatment and specific immune response, we also compared Vd2-negative (Vd2 neg ) cd T cell expansion involved in CMV infection resolution. EOD was defined as occurring <3 mo and LOD as occurring >3 mo after transplantation. Depending on the period, universal prophylaxis or preemptive treatment was used. Overall, 168 D+RÀ KTRs were included between 2003 and 2011. LOD was associated with a lower peak DNAemia (p = 0.04), fewer recurrences (odds ratio 0.16; 95% confidence interval 0.05-0.55; p = 0.01) and shorter anti-CMV curative treatment (40 vs. 60 days, p < 0.0001). As a corollary, we found that Vd2 neg cd T cell expansion was faster in LOD than in EOD (31 vs. 168 days after the beginning of CMV disease, p < 0.0001). In D+RÀ KTRs, universal prophylaxis is associated with more LOD, which had better infection management and a faster immune response. These results support the use of universal prophylaxis over a preemptive strategy and reappraise outcomes of LOD.

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Section: Discussionsupporting

confidence: 76%

Easier Control of Late-Onset Cytomegalovirus Disease Following Universal Prophylaxis Through an Early Antiviral Immune Response in Donor-Positive, Recipient-Negative Kidney Transplants

Kaminski

Couzi

Garrigue³

et al. 2016

American Journal of Transplantation

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“…This was followed by the recipient's age. Others have found that if the recipient's age is >55 [18] or >60 [19] this acts as an independent risk factor for developing HCMV infection or HCMV disease. A further predictive factor was the concomitant use of mycophenolic acid and ciclosporine A from the day of transplantation; this resulted in an Odds ratio of 2.12.…”

Section: Discussionmentioning

confidence: 99%

Pre-emptive intravenous ganciclovir versus valganciclovir prophylaxis for de novo cytomegalovirus-seropositive kidney-transplant recipients

Wéclawiak¹,

Kamar²,

Mengelle³

et al. 2010

Transplant International

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“…Frequently, the infection can cause a clinical picture of pancreatitis, especially if the patient has underwent kidney/pancreas transplantation or had preexisting CMV infection. This digestive manifestation of the CMV infection was shown to be more common in patients treated with cyclosporine A (CsA) [8,9]. If we assess the five or six, commonly used, immunosuppressive medications, we observe that mycophenolate mofetil (MMF) is associated with a higher rate of CMV tissue invasiveness especially in the GI tract [6][7][8]10].…”

Section: Cytomegalovirus (Cmv) Infectionmentioning

confidence: 99%

“…This digestive manifestation of the CMV infection was shown to be more common in patients treated with cyclosporine A (CsA) [8,9]. If we assess the five or six, commonly used, immunosuppressive medications, we observe that mycophenolate mofetil (MMF) is associated with a higher rate of CMV tissue invasiveness especially in the GI tract [6][7][8]10]. Indeed, increased immunosuppression, such as by anti-lymphocyte antibody and conventional MMF therapy is one of the main predisposing factors to CMV infection.…”

Section: Cytomegalovirus (Cmv) Infectionmentioning

confidence: 99%

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Gastrointestinal Side Effects of Post-Transplant Therapy

Lucan

Berardinelli

2016

JGLD

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Modern immunosuppressive therapy has produced a real revolution in renal and organ transplantation but it comes with the price of multiple side effects. There are many gastrointestinal (GI) complications that are the consequence of transplant immunosuppressant medication. In fact, for any immunosuppressant therapy, certain standardized precepts and attitudes that aim to reduce the incidence and the impact of the medication side effects must be applied. Many patients undergo renal transplantation and the physicians have to be aware of the advantages and the risks associated. This article reviews the main GI complications that may arise as a consequence of immunosuppressive therapy after solid organ transplantation, focusing on renal and renal/pancreas transplantation, as well as the ways in which the incidence of these complications can be reduced. Management of the post-transplant therapy is mandatory in order to increase not only the grafts’ and the patients’ survival, but also their quality of life by the occurrence of fewer complications. Abbreviations: Aza: azathioprine; CMV: cytomegalovirus; CsA: cyclosporine A; GI: gastrointestinal; MMF: mycophenolate mofetil; NSAID: non-steroidal anti-inflammatory drugs; Tac: tacrolimus.

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Cytomegalovirus Infection Renal Transplant Recipients: Risk Factors and Outcome

Cited by 47 publications

References 9 publications

Easier Control of Late-Onset Cytomegalovirus Disease Following Universal Prophylaxis Through an Early Antiviral Immune Response in Donor-Positive, Recipient-Negative Kidney Transplants

Easier Control of Late-Onset Cytomegalovirus Disease Following Universal Prophylaxis Through an Early Antiviral Immune Response in Donor-Positive, Recipient-Negative Kidney Transplants

Pre-emptive intravenous ganciclovir versus valganciclovir prophylaxis for de novo cytomegalovirus-seropositive kidney-transplant recipients

Gastrointestinal Side Effects of Post-Transplant Therapy

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