Easier Control of Late‐Onset Cytomegalovirus Disease Following Universal Prophylaxis Through an Early Antiviral Immune Response in Donor‐Positive, Recipient‐Negative Kidney Transplants

Universal prophylaxis for cytomegalovirus ( CMV) prevention is viable but, compared with a preemptive strategy, leads to higher incidence of late‐onset disease ( LOD ) associated with poor patient and graft survival. The purpose of this study was to compare LOD with early onset disease ( EOD ), with a focus on the highest risk kidney transplant recipients ( KTRs ): CMV seronegative recipients transplanted from seropositive donors (D+R−). Since CMV control depends on both antiviral treatment and specific immune response, we also compared Vδ2‐negative (Vδ2 neg ) γδ T cell expansion involved in CMV infection resolution. EOD was defined as occurring <3 mo and LOD as occurring >3 mo after transplantation. Depending on the period, universal prophylaxis or preemptive treatment was used. Overall, 168 D+R− KTRs were included between 2003 and 2011. LOD was associated with a lower peak DNA emia (p = 0.04), fewer recurrences (odds ratio 0.16; 95% confidence interval 0.05–0.55; p = 0.01) and shorter anti‐ CMV curative treatment (40 vs. 60 days, p < 0.0001). As a corollary, we found that Vδ2 neg γδ T cell expansion was faster in LOD than in EOD (31 vs. 168 days after the beginning of CMV disease, p < 0.0001). In D+R− KTRs , universal prophylaxis is associated with more LOD, which had better infection management and a faster immune response. These results support the use of universal prophylaxis over a preemptive strategy and reappraise outcomes of LOD .