Intragraft cytomegalovirus infection: a randomized trial of valacyclovir prophylaxis versus pre-emptive therapy in renal transplant recipients
Language English Country Great Britain, England Media print
Document type Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't
PubMed
20167988
DOI
10.3851/imp1485
Knihovny.cz E-resources
- MeSH
- Acyclovir administration & dosage analogs & derivatives MeSH
- Antiviral Agents administration & dosage MeSH
- Cytomegalovirus Infections drug therapy etiology prevention & control MeSH
- Cytomegalovirus drug effects MeSH
- Double-Blind Method MeSH
- Ganciclovir administration & dosage analogs & derivatives MeSH
- Transplantation, Homologous MeSH
- Humans MeSH
- Postoperative Complications * MeSH
- Premedication * MeSH
- Graft Rejection MeSH
- Risk Factors MeSH
- Kidney Transplantation * MeSH
- Valacyclovir MeSH
- Valganciclovir MeSH
- Valine administration & dosage analogs & derivatives MeSH
- Viremia drug therapy etiology prevention & control MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
- Comparative Study MeSH
- Names of Substances
- Acyclovir MeSH
- Antiviral Agents MeSH
- Ganciclovir MeSH
- Valacyclovir MeSH
- Valganciclovir MeSH
- Valine MeSH
BACKGROUND: In a randomized study, we observed a higher incidence of biopsy-proven acute rejection with pre-emptive valganciclovir therapy as compared with valacyclovir prophylaxis for prevention of cytomegalovirus (CMV) disease after renal transplantation (RTx). Persistence of the virus within the allograft could stimulate the alloimmune response. The aim of our study was to evaluate intragraft CMV infection in patients randomized to the trial. METHODS: RTx recipients at risk of CMV were randomized to pre-emptive therapy with valganciclovir (n=36) for significant CMV viraemia (> or =2,000 copies/ml by quantitative PCR in whole blood samples) or 3-month prophylaxis with valacyclovir (n=34). Renal biopsies performed during 12 months post-RTx were analysed for the presence of CMV by real-time PCR and immunohistochemical staining. RESULTS: A total of 35 patients (59 biopsies) in the pre-emptive group and 31 patients (57 biopsies) with valacyclovir prophylaxis had > or =1 biopsy specimen with sufficient material for intragraft CMV determination. Cumulative incidence of intragraft CMV infection was 14% and 7% (P=0.315) with pre-emptive therapy and prophylaxis, respectively. Patients at risk for primary CMV infection (CMV serological donor-positive and recipient-negative) were at higher risk for intragraft CMV infection (40% versus 5%; P=0.008). CMV viraemia at the time of biopsy was associated with the presence of CMV within the allograft (P<0.001). CONCLUSIONS: During the first year after RTx, the incidence of intragraft CMV infection was relatively low with comparable rates in patients managed by pre-emptive valganciclovir therapy and valacyclovir prophylaxis.
References provided by Crossref.org
