Cytomegalovirus High-risk Kidney Transplant Recipients Show No Difference in Long-term Outcomes Following Preemptive Versus Prophylactic Management

Following kidney transplantation (KT), cytomegalovirus (CMV) infection remains an important challenge. Both prophylactic and preemptive antiviral protocols are used for CMV high-risk kidney recipients (donor seropositive/recipient seronegative; D+/R-). We performed a nationwide comparison of the 2 s...

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Veröffentlicht in:Transplantation 2023-08, Vol.107 (8), p.1846-1853
Hauptverfasser: Blom, Kjersti B., Birkeland, Grete K., Midtvedt, Karsten, Jenssen, Trond G., Reisæter, Anna V., Rollag, Halvor, Hartmann, Anders, Sagedal, Solbjørg, Sjaastad, Ivar, Tylden, Garth, Njølstad, Gro, Nilsen, Einar, Christensen, Andreas, Åsberg, Anders, Birkeland, Jon A.
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Sprache:eng
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Zusammenfassung:Following kidney transplantation (KT), cytomegalovirus (CMV) infection remains an important challenge. Both prophylactic and preemptive antiviral protocols are used for CMV high-risk kidney recipients (donor seropositive/recipient seronegative; D+/R-). We performed a nationwide comparison of the 2 strategies in de novo D+/R- KT recipients accessing long-term outcomes. A nationwide retrospective study was conducted from 2007 to 2018, with follow-up until February 1, 2022. All adult D+/R- and R+ KT recipients were included. During the first 4 y, D+/R- recipients were managed preemptively, changing to 6 mo of valganciclovir prophylaxis from 2011. To adjust for the 2 time eras, de novo intermediate-risk (R+) recipients, who received preemptive CMV therapy throughout the study period, served as longitudinal controls for possible confounders. A total of 2198 KT recipients (D+/R-, n = 428; R+, n = 1770) were included with a median follow-up of 9.4 (range, 3.1-15.1) y. As expected, a greater proportion experienced a CMV infection in the preemptive era compared with the prophylactic era and with a shorter time from KT to CMV infection ( P  
ISSN:0041-1337
1534-6080
DOI:10.1097/TP.0000000000004615