Cytomegalovirus prevention strategies in seropositive kidney transplant recipients: an insight into current clinical practice

There is notable heterogeneity in the implementation of cytomegalovirus (CMV) prevention practices among CMV-seropositive (R+) kidney transplant (KT) recipients. In this prospective observational study, we included 387 CMV R+ KT recipients from 25 Spanish centers. Prevention strategies (antiviral pr...

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Authors: Fernandez-Ruiz, M, Arias, M, Campistol, JM, Navarro, D, Gomez-Huertas, E, Gomez-Marquez, G, Diaz, JM, Hernandez, D, Bernal-Blanco, G, Cofan, F, Jimeno, L, Franco-Esteve, A, Gonzalez, E, Moreso, FJ, Gomez-Alamillo, C, Mendiluce, A, Luna-Huerta, E, Aguado, JM
Format: article
Status:Published version
Publication Date:2015
Country:España
Institution:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repository:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p8355
Online Access:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=8355
Access Level:Open access
Keyword:antiviral prophylaxis
cytomegalovirus
kidney transplantation
multicenter study
preemptive therapy
seropositive recipient
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spelling Cytomegalovirus prevention strategies in seropositive kidney transplant recipients: an insight into current clinical practiceFernandez-Ruiz, MArias, MCampistol, JMNavarro, DGomez-Huertas, EGomez-Marquez, GDiaz, JMHernandez, DBernal-Blanco, GCofan, FJimeno, LFranco-Esteve, AGonzalez, EMoreso, FJGomez-Alamillo, CMendiluce, ALuna-Huerta, EAguado, JMantiviral prophylaxiscytomegaloviruskidney transplantationmulticenter studypreemptive therapyseropositive recipientThere is notable heterogeneity in the implementation of cytomegalovirus (CMV) prevention practices among CMV-seropositive (R+) kidney transplant (KT) recipients. In this prospective observational study, we included 387 CMV R+ KT recipients from 25 Spanish centers. Prevention strategies (antiviral prophylaxis or preemptive therapy) were applied according to institutional protocols at each site. The impact on the 12-month incidence of CMV disease was assessed by Cox regression. Asymptomatic CMV infection, acute rejection, graft function, non-CMV infection, graft loss, and all-cause mortality were also analyzed (secondary outcomes). Models were adjusted for a propensity score (PS) analysis for receiving antiviral prophylaxis. Overall, 190 patients (49.1%) received preemptive therapy, 185 (47.8%) antiviral prophylaxis, and 12 (3.1%) no specific intervention. Twelve-month cumulative incidences of CMV disease and asymptomatic infection were 3.6% and 39.3%, respectively. Patients on prophylaxis had lower incidence of CMV disease [PS-adjusted HR (aHR): 0.10; 95% confidence interval (CI): 0.01-0.79] and asymptomatic infection (aHR: 0.46; 95% CI: 0.29-0.72) than those managed preemptively, with no significant differences according to the duration of prophylaxis. All cases of CMV disease in the prophylaxis group occurred after prophylaxis discontinuation. There were no differences in any of the secondary outcomes. In conclusion, antiviral prophylaxis was associated with a lower occurrence of CMV disease in CMV R+ KT recipients, although such benefit should be balanced with the risk of late-onset disease.WILEY2015info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=8355TRANSPLANT INTERNATIONALISSN: 09340874ISSNe: 14322277reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Inglésinfo:eu-repo/semantics/openAccessoai:iibsantpau.fundanetsuite.com:p83552026-06-14T12:41:47Z
dc.title.none.fl_str_mv Cytomegalovirus prevention strategies in seropositive kidney transplant recipients: an insight into current clinical practice
title Cytomegalovirus prevention strategies in seropositive kidney transplant recipients: an insight into current clinical practice
spellingShingle Cytomegalovirus prevention strategies in seropositive kidney transplant recipients: an insight into current clinical practice
Fernandez-Ruiz, M
antiviral prophylaxis
cytomegalovirus
kidney transplantation
multicenter study
preemptive therapy
seropositive recipient
title_short Cytomegalovirus prevention strategies in seropositive kidney transplant recipients: an insight into current clinical practice
title_full Cytomegalovirus prevention strategies in seropositive kidney transplant recipients: an insight into current clinical practice
title_fullStr Cytomegalovirus prevention strategies in seropositive kidney transplant recipients: an insight into current clinical practice
title_full_unstemmed Cytomegalovirus prevention strategies in seropositive kidney transplant recipients: an insight into current clinical practice
title_sort Cytomegalovirus prevention strategies in seropositive kidney transplant recipients: an insight into current clinical practice
dc.creator.none.fl_str_mv Fernandez-Ruiz, M
Arias, M
Campistol, JM
Navarro, D
Gomez-Huertas, E
Gomez-Marquez, G
Diaz, JM
Hernandez, D
Bernal-Blanco, G
Cofan, F
Jimeno, L
Franco-Esteve, A
Gonzalez, E
Moreso, FJ
Gomez-Alamillo, C
Mendiluce, A
Luna-Huerta, E
Aguado, JM
author Fernandez-Ruiz, M
author_facet Fernandez-Ruiz, M
Arias, M
Campistol, JM
Navarro, D
Gomez-Huertas, E
Gomez-Marquez, G
Diaz, JM
Hernandez, D
Bernal-Blanco, G
Cofan, F
Jimeno, L
Franco-Esteve, A
Gonzalez, E
Moreso, FJ
Gomez-Alamillo, C
Mendiluce, A
Luna-Huerta, E
Aguado, JM
author_role author
author2 Arias, M
Campistol, JM
Navarro, D
Gomez-Huertas, E
Gomez-Marquez, G
Diaz, JM
Hernandez, D
Bernal-Blanco, G
Cofan, F
Jimeno, L
Franco-Esteve, A
Gonzalez, E
Moreso, FJ
Gomez-Alamillo, C
Mendiluce, A
Luna-Huerta, E
Aguado, JM
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv antiviral prophylaxis
cytomegalovirus
kidney transplantation
multicenter study
preemptive therapy
seropositive recipient
topic antiviral prophylaxis
cytomegalovirus
kidney transplantation
multicenter study
preemptive therapy
seropositive recipient
description There is notable heterogeneity in the implementation of cytomegalovirus (CMV) prevention practices among CMV-seropositive (R+) kidney transplant (KT) recipients. In this prospective observational study, we included 387 CMV R+ KT recipients from 25 Spanish centers. Prevention strategies (antiviral prophylaxis or preemptive therapy) were applied according to institutional protocols at each site. The impact on the 12-month incidence of CMV disease was assessed by Cox regression. Asymptomatic CMV infection, acute rejection, graft function, non-CMV infection, graft loss, and all-cause mortality were also analyzed (secondary outcomes). Models were adjusted for a propensity score (PS) analysis for receiving antiviral prophylaxis. Overall, 190 patients (49.1%) received preemptive therapy, 185 (47.8%) antiviral prophylaxis, and 12 (3.1%) no specific intervention. Twelve-month cumulative incidences of CMV disease and asymptomatic infection were 3.6% and 39.3%, respectively. Patients on prophylaxis had lower incidence of CMV disease [PS-adjusted HR (aHR): 0.10; 95% confidence interval (CI): 0.01-0.79] and asymptomatic infection (aHR: 0.46; 95% CI: 0.29-0.72) than those managed preemptively, with no significant differences according to the duration of prophylaxis. All cases of CMV disease in the prophylaxis group occurred after prophylaxis discontinuation. There were no differences in any of the secondary outcomes. In conclusion, antiviral prophylaxis was associated with a lower occurrence of CMV disease in CMV R+ KT recipients, although such benefit should be balanced with the risk of late-onset disease.
publishDate 2015
dc.date.none.fl_str_mv 2015
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=8355
url https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=8355
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv WILEY
publisher.none.fl_str_mv WILEY
dc.source.none.fl_str_mv TRANSPLANT INTERNATIONAL
ISSN: 09340874
ISSNe: 14322277
reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
instname_str Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
reponame_str r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
collection r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,811543

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