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

Abstract

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.

Conversion to mTOR Inhibitor to Reduce the Incidence of Cytomegalovirus Recurrence in Kidney Transplant Recipients Receiving Preemptive Treatment: A Prospective, Randomized Trial

“…A recent study showed no difference between the antigenemia versus DNAemia tests regarding the incidence and recurrence of CMV infection/disease. 25 The results observed here cannot be extrapolated to other populations, including high-immunological-risk patients, D + /R – CMV serology high-risk KTRs, and pediatric recipients.…”

Long-term CMV monitoring and chronic rejection in renal transplant recipients

“…The antigenemia assay was the only way that was covered by Japanese medical insurance during this study. However, the CMV pp65 antigenemia assay is comparable to CMV QNAT in its ability to provide rapid and sensitive diagnosis of CMV disease and guide treatment options ( Caliendo et al., 2000 ; Pang et al., 2003 ; Razonable and Humar, 2019 ; Nakamura et al., 2022 ). The optimal cut-off value of CMV-Ag in the chronic phase after KTx is unclear.…”

The Association Between Kidney Donor Profile Index and 1-y Graft Function

“…CMV disease was based on the evidence of CMV replication, regardless of the number of pp65 positive cells or the DNAemia, and associated symptoms. 19 Graft loss was defined as the definitive need to return to dialysis. The biopsy-proven acute rejection (BPAR), including borderline changes, was categorized according to the Banff 2013 classification.…”