Cytomegalovirus Prophylaxis and Graft Outcome in Solid Organ Transplantation: A Collaborative Transplant Study Report

Abstract

We investigated relationships between cytomegalovirus (CMV) seropairing and CMV prophylaxis on graft outcome in recipients of solid organ transplants. Transplants carried out from 1985 to 2002 and reported to the Collaborative Transplant Study were analyzed. In cadaver kidney recipients, CMV prophylaxis was significantly associated with improved graft survival only in the seronegativerecipient/seropositive-donor combination (at 3 years: 79.4% with prophylaxis vs. 73.5% without prophylaxis; RR 0.80, p < 0.0001). Among patients who had a functioning graft at 1 year, significantly fewer patients who received CMV prophylaxis received rejection treatment in the preceding year (26.3%), compared with patients who did not receive prophylaxis (32.4%) (p = = 0.0001), suggesting an inhibitory effect of CMV prophylaxis on acute rejection. Significant improvements in graft survival after CMV prophylaxis were found also in CMV-negative recipients of CMV-positive heart, and lung or heart-lung transplants, but not liver transplants. The age of the recipient had a differential effect on graft and patient survival after CMV prophylaxis. Use of antilymphocyte antibodies or mycophenolate mofetil was not associated with an enhanced CMV effect on graft outcome. These results may contribute to a better understanding of the influence of pretransplant CMV serology on the effect of CMV prophylaxis.

The Cell Biology of Cytomegalovirus: Implications for Transplantation

“…Both direct and indirect effects are often present simultaneously, and the relative clinical contributions of any of these mechanisms are uncertain. In general, CMV seropositivity and receipt of seropositive organs and viremia are linked in many, but not all, studies to diminished long-term graft function (16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Furthermore, most studies have indicated that successful antiviral prophylaxis has a beneficial effect on long-term graft function (8).…”

Complications of Kidney Transplantation: Effects of Over-Immunosuppression

“…Risk factors for CMV infection/disease include CMV donorpositive/recipient-negative (D+/R-) serostatus pairs, recent treatment for acute rejection, recent completion of prophylactic antiviral therapy, and rabbit anti-thymocyte globulin induction therapy [53,54]. In CMV D+/R-pairs, there may be an association between the use of CMV prophylaxis and improved graft survival and lower acute rejection rates [55].…”

Achieving an early pregnancy following allogeneic uterine transplantation in a rabbit model

“…Nevertheless, we must acknowledge that long-term data on allograft loss, maternal survival after pregnancy (due to an increased risk of viral diseases and neoplasm secondary to immunosuppressants) 15 and offspring outcomes of transplant recipients is rather limited. Despite several reports indicating no increase of congenital anomalies among the offspring of recipients, 14,16 long-term outcomes focusing on physical and mental development, and immunological and oncological pathologies later in life in these offspring is necessary.…”