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ORIGINAL ARTICLE
Year : 2019  |  Volume : 19  |  Issue : 3  |  Page : 68-74

Universal prophylaxis with valganciclovir versus preemptive therapy in minimizing the risk of cytomegalovirus infection and disease in high-risk and intermediate-risk kidney transplant recipients: a single-center experience


Renal Transplant Unit, National Institute of Solid Organ and Tissue Transplantation, Dow University of Health Sciences, Karachi, Pakistan

Correspondence Address:
MBBS, MRCP (UK), FCPS Muhammad Tassaduq Khan
Renal Transplant Unit, National Institute of Solid Organ and Tissue Transplantation, Dow University of Health Sciences, Ojha Campus, Karachi
Pakistan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jesnt.jesnt_18_19

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Objective Cytomegalovirus (CMV) is one of the most frequent viral pathogens that results in post-transplantation infection. Universal prophylaxis and preemptive therapy have long been used to prevent and treat CMV infection, respectively, in post-transplantation cases. The aim of this study was to compare the universal prophylaxis with valganciclovir versus preemptive therapy in minimizing the risk of CMV infection and disease in high-risk and intermediate-risk kidney transplant recipients. Patients and methods This single-center, retrospective cohort study enrolled 63 kidney transplant recipients between March 2017 and January 2018. The outcome variables were occurrence of CMV infection and CMV disease, 1-year estimated glomerular filtration rate (eGFR), allograft rejection, allograft loss, and mortality within the first year after transplantation in high-risk (D+/R−) patients managed with universal prophylaxis of oral valganciclovir and intermediate-risk (D+/R+ or D−/R+) patients receiving preemptive treatment. Results Of the 63 kidney transplant recipients, 19 (30.2%) were grouped as high risk for CMV infection/disease and 44 (69.8%) were intermediate risk for CMV infection/disease. The average duration of post-transplantation follow-up was 349 (SD 136) days in the high-risk cohort and 335 (SD 112) days in the intermediate-risk cohort (P=0.56). CMV infection was found in 15 (34.1%) of the 44 intermediate-risk patients receiving preemptive therapy and in four (21.1%) of the 19 high-risk patients receiving universal prophylaxis (P<0.01). CMV disease developed in seven (15.9%) of the 44 intermediate-risk patients and in one (5.3%) of the 19 high-risk patients (P<0.01). Allograft rejection was found to be higher in intermediate-risk group than in high-risk group (18.2 vs. 15.8%, P=0.44). Allograft loss and mortality were also comparable between the intermediate-risk and high-risk cohorts (13.6 vs. 10.5%, P=0.54 and 0 vs. 0%, P=0.15, respectively). The mean eGFR at 1 year after transplantation was similar in both the cohorts: intermediate-risk (52.5±21.8) and high-risk (54.3±23.2) (P=0.68) cohorts. Conclusion Intermediate-risk (D+/R+ or D−/R+) kidney transplant recipients receiving preemptive therapy had significantly higher frequency of CMV infection/disease than high-risk (D+/R−) kidney transplant recipients receiving oral valganciclovir universal prophylaxis during early post-transplantation period. No statistically significant differences were found in relation to allograft rejection, allograft loss, eGFR, and mortality at 1 year in both the cohorts.


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