Impact of antiviral preventive strategies on the incidence and outcomes of cytomegalovirus disease in solid organ transplant recipients.
- Manuel O Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland; Infectious Diseases Service, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
- Kralidis G
- Mueller NJ
- Hirsch HH
- Garzoni C
- van Delden C
- Berger C
- Boggian K
- Cusini A
- Koller MT
- Weisser M
- Pascual M
- Meylan PR
- 2013-08-07
Published in:
- American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. - 2013
Antiviral prophylaxis
graft loss
indirect effects
preemptive therapy
valganciclovir
Adult
Aged
Antiviral Agents
Cytomegalovirus
Cytomegalovirus Infections
Female
Ganciclovir
Graft Survival
Humans
Incidence
Male
Middle Aged
Organ Transplantation
Prospective Studies
Risk Factors
Valganciclovir
English
We assessed the impact of antiviral prophylaxis and preemptive therapy on the incidence and outcomes of cytomegalovirus (CMV) disease in a nationwide prospective cohort of solid organ transplant recipients. Risk factors associated with CMV disease and graft failure-free survival were analyzed using Cox regression models. One thousand two hundred thirty-nine patients transplanted from May 2008 until March 2011 were included; 466 (38%) patients received CMV prophylaxis and 522 (42%) patients were managed preemptively. Overall incidence of CMV disease was 6.05% and was linked to CMV serostatus (D+/R- vs. R+, hazard ratio [HR] 5.36 [95% CI 3.14-9.14], p < 0.001). No difference in the incidence of CMV disease was observed in patients receiving antiviral prophylaxis as compared to the preemptive approach (HR 1.16 [95% CI 0.63-2.17], p = 0.63). CMV disease was not associated with a lower graft failure-free survival (HR 1.27 [95% CI 0.64-2.53], p = 0.50). Nevertheless, patients followed by the preemptive approach had an inferior graft failure-free survival after a median of 1.05 years of follow-up (HR 1.63 [95% CI 1.01-2.64], p = 0.044). The incidence of CMV disease in this cohort was low and not influenced by the preventive strategy used. However, patients on CMV prophylaxis were more likely to be free from graft failure.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1111/ajt.12388
- PMID 23914796
- Persistent URL
- https://folia.unifr.ch/global/documents/49023
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