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Cytomegalovirus prophylaxis in seropositive renal transplant recipients receiving thymoglobulin induction therapy: Outcome and risk factors for late CMV disease
Author(s) -
Reusing Jose O.,
Feitosa Emanoela B.,
Agena Fabiana,
Pierrotti Lígia C.,
Azevedo Luiz S. F.,
Kotton Camille N.,
DavidNeto Elias
Publication year - 2018
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12929
Subject(s) - medicine , thymoglobulin , cytomegalovirus , valganciclovir , cohort , disease , immunology , anti thymocyte globulin , immunosuppression , retrospective cohort study , gastroenterology , risk factor , transplantation , ganciclovir , human cytomegalovirus , tacrolimus , viral disease , virus , herpesviridae
Background Anti‐thymocyte globulin ( ATG ) therapy is a risk factor for cytomegalovirus ( CMV ) disease in renal transplant ( RT x) recipients and therefore antiviral prophylaxis is commonly used. We evaluated the outcome of our current policy of 90 days of CMV prophylaxis in seropositive recipients given ATG and the risk factors for the occurrence of CMV disease after prophylaxis. Methods We studied a retrospective cohort of 423 RT x (2010‐2014) CMV ‐seropositive adults given ATG induction therapy. Results 54 (13%) patients developed CMV disease at a median of 163 days after transplant, of which 29 (54%) had viral syndrome and 25 (46%) had invasive disease. Median prophylaxis time (94 days) and immunosuppressive drugs were similar between groups ( CMV vs no‐ CMV ). Those with CMV disease had more deceased donors and higher donor age, lower lymphocyte count, and lower median eGFR at day 90. Multivariable logistic regression analysis at day 90 and 180 found that eGFR ≤40 ml/min/1.73 m 2 (but not acute rejection) was associated with late CMV disease. In a separate validation cohort of 124 patients with 8% late CMV disease, eGFR ≤45 and lymphocyte count ≤800 cells/mm 3 at the end of prophylaxis remained predictive of late CMV disease occurrence. Conclusions These data indicate that antiviral prophylaxis adequately prevented CMV in seropositive recipients given ATG , but late disease still occurred. Low eGFR and low lymphocyte count at the end of prophylaxis may help identify patients at higher risk of CMV disease.