KHA‐CARI guideline: Cytomegalovirus disease and kidney transplantation

Pilmore, Helen; Pussell, Bruce A.; Goodman, David

doi:10.1111/j.1440-1797.2011.01521.x

Cited by 5 publications

(4 citation statements)

References 21 publications

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“…Use of the antigenemia assay to monitor CMV infection and support pre-emptive therapy has been recommended by international guidelines for management of transplant patients [ 10 20 ]. However, the cutoff point associated with the risk of symptomatic infection or that suggested for the onset of therapy has not been established, thus each center should establish and use their own cutoff point which would range from 1 to 50 positive cells per slide with 200,000 leukocytes [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Cytomegalovirus Infection after Renal Transplantation: Occurrence, Clinical Features, and the Cutoff for Antigenemia in a University Hospital in Brazil

2017

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BackgroundCytomegalovirus (CMV) is the main infectious agent causative of morbidity and mortality in transplant recipients. This study aimed to describe the occurrence and clinical features of CMV infection, and the optimum antigenemia assay cutoff associated with symptomatic infection.Materials and MethodsThis was a cohort study that investigated 87 patients undergoing renal transplantation. The patients were monitored with the CMV antigenemia assay performed weekly for the first 3 months post-transplantation and subsequently, when CMV infection was suspected clinically.ResultsCMV infection was observed in 63.2% (55/87) of the recipients during the follow-up. Of the 65 episodes observed, 75% (49/65) occurred until 100 days after transplantation (D+100) and 25% (16/65) after D+100 with a median of 60 days. CMV infection was associated with age of the transplant recipients (P = 0.001) and use of deceased donor organ (P = 0.009). There were asymptomatic (34%) and symptomatic (66%) episodes of CMV infection, in which diarrhea was the most common symptom (22.6%), followed by elevated creatinine levels (14.5%), fever (12.9%) and leukopenia (10.5%). The optimum cutoff point associated with symptomatic infection was 5 positive cells/200,000 leukocytes (area under the curve = 0.87, positive predictive value = 88% and negative predictive value= 71%).ConclusionsThe high occurrence and the risk factors for CMV infection such as the age of recipients, the number of positive cells in the antigenemia assay, and use of a deceased donor organ should be considered for appropriate monitoring and management of kidney recipients during the post-transplant period.

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Section: Discussionmentioning

confidence: 99%

Cytomegalovirus Infection after Renal Transplantation: Occurrence, Clinical Features, and the Cutoff for Antigenemia in a University Hospital in Brazil

2017

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“…Oral CMV-prophylaxis with valganciclovir was administered over 100 days for donors (D+)/recipients (R−), D+/R+, and D−/R+ recipients, over 200 days for D+/R− recipients beyond June, 2009, and none if both the donor and the recipient were negative for CMV [13]. CMV viremia (considered relevant if >214.6 copies/mL corresponding to the threshold value given by the manufacturer (90% CI 163 to 355 IU/mL) was documented.…”

Section: CMVmentioning

confidence: 99%

Cytomegalovirus Viremia after Living and Deceased Donation in Kidney Transplantation

Jehn

Schütte‐Nütgen

Bautz

et al. 2020

JCM

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Despite screening, effective anti-viral drugs and risk-balanced prophylaxis, cytomegalovirus (CMV) remains a major cause of morbidity in transplant patients. The objective of this study was to retrospectively analyze the risk factors associated with CMV viremia after kidney transplantation in a large European cohort with standardized valganciclovir prophylaxis in the present era. A special focus was placed on the comparison of living and postmortal donation. We conducted a longitudinal observational study involving 723 adult patients with a total of 3292 patient-years who were transplanted at our center between 2007 and 2015. Valganciclovir prophylaxis was administered over 100 days for CMV+ donors (D) or recipients (R), over 200 days for D+/R−, and none in D−/R−. A CMV+ donor, rejection episodes, and deceased donor transplantation were identified to be associated with increased incidences of CMV viremia. Although we did not find a reduced overall survival rate for patients with CMV viremia, it was associated with worse graft function. Since we observed a relevant number of CMV infections despite prescribing valganciclovir prophylaxis, a pre-emptive strategy in patients with (suspected) adherence restrictions could be favored. Our data can help transplant physicians educate their patients about their individual CMV risk and choose the most appropriate CMV treatment approach.

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“…The current Australian guidelines recommend 3 months of antiviral prophylaxis for D + /R + and D − /R + recipients, 6 months for D + /R − recipients, and none if both donor and recipient were negative for CMV [7]. CMV prophylaxis has been shown to reduce the risk of CMV disease and all-cause mortality in renal transplant recipients [8].…”

Section: Introductionmentioning

confidence: 99%

Cytomegalovirus viraemia and mortality in renal transplant recipients in the era of antiviral prophylaxis. Lessons from the western Australian experience

et al. 2017

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BackgroundCytomegalovirus (CMV) establishes a lifelong infection that is efficiently controlled by the immune system; this infection can be reactivated in case of immunosuppression such as following solid organ transplantation. CMV viraemia has been associated with CMV disease, as well as increased mortality and allograft failure. Prophylactic antiviral medication is routinely given to renal transplant recipients, but reactivation during and following cessation of antiviral prophylaxis is known to occur. The aims of this study were to assess the incidence, timing and impact of CMV viraemia in renal transplant recipients and to determine the level of viraemia associated with adverse clinical outcomes.MethodsData from all adult (18 years and over) Western Australian renal transplant recipients transplanted between 1 January 2007 and 31 December 2012 were obtained from the Australia and New Zealand Dialysis and Transplant registry and were supplemented with data obtained from clinical records. Potential risk factors for detectable CMV viraemia (≥600 copies/ml) and all-cause mortality were assessed using univariable analysis and Cox Proportional Hazards Regression.ResultsThere were 438 transplants performed on 435 recipients. The following factors increased the risk of CMV viraemia with viral loads ≥600 copies/ml: Donor positive/Recipient negative status; receiving a graft from a deceased donor; and receiving a graft from a donor aged 60 years and over. CMV viraemia with viral loads ≥656 copies/ml was a risk factor for death following renal transplantation, as was being aged 65 years and above at transplant, being Aboriginal and having vascular disease. Importantly 37% of the episodes of CMV viraemia with viral loads ≥656 copies/ml occurred while the patients were expected to be on CMV prophylaxis.ConclusionsCMV viraemia (≥656 copies/ml) was associated with all-cause mortality in multivariable analysis, and CMV viraemia at ≥656 copies/ml commonly occurred during the period when renal transplant recipients were expected to be on antiviral prophylaxis. A greater vigilance in monitoring CMV levels if antiviral prophylaxis is stopped prematurely or poor patient compliance is suspected could protect some renal transplant recipients from adverse outcomes such as premature mortality.

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KHA‐CARI guideline: Cytomegalovirus disease and kidney transplantation

Abstract: AT A GLANCEThis paper summarises the updated guidelines for diagnostic tests, prophylaxis and treatment options for cytomegalovirus after transplantation.

Cited by 5 publications

References 21 publications

Cytomegalovirus Infection after Renal Transplantation: Occurrence, Clinical Features, and the Cutoff for Antigenemia in a University Hospital in Brazil

Cytomegalovirus Infection after Renal Transplantation: Occurrence, Clinical Features, and the Cutoff for Antigenemia in a University Hospital in Brazil

Cytomegalovirus Viremia after Living and Deceased Donation in Kidney Transplantation

Cytomegalovirus viraemia and mortality in renal transplant recipients in the era of antiviral prophylaxis. Lessons from the western Australian experience

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