Impact of Antiviral Preventive Strategies on the Incidence and Outcomes of Cytomegalovirus Disease in Solid Organ Transplant Recipients
We assessed the impact of antiviral prophylaxis and preemptive therapy on the incidence and outcomes of cytomegalovirus (CMV) disease in a nationwide prospective cohort of solid organ transplant recipients. Risk factors associated with CMV disease and graft failure‐free survival were analyzed using...
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| Veröffentlicht in: | American journal of transplantation 2013-09, Vol.13 (9), p.2402-2410 |
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| creator | Manuel, O. Kralidis, G. Mueller, N. J. Hirsch, H. H. Garzoni, C. van Delden, C. Berger, C. Boggian, K. Cusini, A. Koller, M. T. Weisser, M. Pascual, M. Meylan, P. R. |
| description | We assessed the impact of antiviral prophylaxis and preemptive therapy on the incidence and outcomes of cytomegalovirus (CMV) disease in a nationwide prospective cohort of solid organ transplant recipients. Risk factors associated with CMV disease and graft failure‐free survival were analyzed using Cox regression models. One thousand two hundred thirty‐nine patients transplanted from May 2008 until March 2011 were included; 466 (38%) patients received CMV prophylaxis and 522 (42%) patients were managed preemptively. Overall incidence of CMV disease was 6.05% and was linked to CMV serostatus (D+/R− vs. R+, hazard ratio [HR] 5.36 [95% CI 3.14–9.14], p |
| doi_str_mv | 10.1111/ajt.12388 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1439217354</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1433273408</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4518-88c3b4cbaf29929dd5d5d5ddf1fe25998c98f68db567b2c92782559c870202573</originalsourceid><addsrcrecordid>eNqN0d1qFDEUAOAgFlurF76ABESoF9vmZzKTXC5rtVsKFbteD5nMyZplJjMmmco-ga9ttrutIAgmFzkhH-ckOQi9oeSc5nGhN-mcMi7lM3RCS0JmJS3486eYi2P0MsYNIbRikr1Ax4wrWlSqPEG_lv2oTcKDxXOf3L0LusNfAtzDbgf4LgWdYO0g4sHj9B3w0hvXgjeAtW_x7ZTM0O9OLV5sUw7Xuhtyminijy6CjoCdx3dD5zIOa-3xKmgfx077hL-CcaPLpeIrdGR1F-H1YT1F3z5drhZXs5vbz8vF_GZmCkHlTErDm8I02jKlmGpb8TBbSy0woZQ0StpSto0oq4YZxSrJhFBGVoQRJip-is72eccw_Jggprp30UCXrwPDFOv8cYrRiovifyhnFS-IzPTdX3QzTMHnh2TFZMkKVpRZfdgrE4YYA9h6DK7XYVtTUu8aWedG1g-NzPbtIePU9NA-ycfOZfD-AHQ0urP5U42Lf1wly4IKkd3F3v10HWz_XbGeX6_2pX8Do7W0XA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1428624246</pqid></control><display><type>article</type><title>Impact of Antiviral Preventive Strategies on the Incidence and Outcomes of Cytomegalovirus Disease in Solid Organ Transplant Recipients</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Manuel, O. ; Kralidis, G. ; Mueller, N. J. ; Hirsch, H. H. ; Garzoni, C. ; van Delden, C. ; Berger, C. ; Boggian, K. ; Cusini, A. ; Koller, M. T. ; Weisser, M. ; Pascual, M. ; Meylan, P. R.</creator><creatorcontrib>Manuel, O. ; Kralidis, G. ; Mueller, N. J. ; Hirsch, H. H. ; Garzoni, C. ; van Delden, C. ; Berger, C. ; Boggian, K. ; Cusini, A. ; Koller, M. T. ; Weisser, M. ; Pascual, M. ; Meylan, P. R. ; Swiss Transplant Cohort Study</creatorcontrib><description>We assessed the impact of antiviral prophylaxis and preemptive therapy on the incidence and outcomes of cytomegalovirus (CMV) disease in a nationwide prospective cohort of solid organ transplant recipients. Risk factors associated with CMV disease and graft failure‐free survival were analyzed using Cox regression models. One thousand two hundred thirty‐nine patients transplanted from May 2008 until March 2011 were included; 466 (38%) patients received CMV prophylaxis and 522 (42%) patients were managed preemptively. Overall incidence of CMV disease was 6.05% and was linked to CMV serostatus (D+/R− vs. R+, hazard ratio [HR] 5.36 [95% CI 3.14–9.14], p < 0.001). No difference in the incidence of CMV disease was observed in patients receiving antiviral prophylaxis as compared to the preemptive approach (HR 1.16 [95% CI 0.63–2.17], p = 0.63). CMV disease was not associated with a lower graft failure‐free survival (HR 1.27 [95% CI 0.64–2.53], p = 0.50). Nevertheless, patients followed by the preemptive approach had an inferior graft failure‐free survival after a median of 1.05 years of follow‐up (HR 1.63 [95% CI 1.01–2.64], p = 0.044). The incidence of CMV disease in this cohort was low and not influenced by the preventive strategy used. However, patients on CMV prophylaxis were more likely to be free from graft failure.
In this nationwide cohort of solid organ transplant recipients, the authors find that the incidence of cytomegalovirus disease is similar irrespective of the antiviral preventive strategy used (preemptive vs. prophylaxis), although patients who received antiviral prophylaxis have better graft failure‐free survival.</description><identifier>ISSN: 1600-6135</identifier><identifier>EISSN: 1600-6143</identifier><identifier>DOI: 10.1111/ajt.12388</identifier><identifier>PMID: 23914796</identifier><language>eng</language><publisher>Hoboken, NJ: Wiley</publisher><subject>Adult ; Aged ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Antiviral agents ; Antiviral Agents - therapeutic use ; Antiviral prophylaxis ; Biological and medical sciences ; Cytomegalovirus ; Cytomegalovirus Infections - epidemiology ; Cytomegalovirus Infections - prevention & control ; Disease prevention ; Female ; Ganciclovir - analogs & derivatives ; Ganciclovir - therapeutic use ; graft loss ; Graft Survival ; Herpesviridae ; Humans ; Incidence ; indirect effects ; Male ; Medical sciences ; Middle Aged ; Organ Transplantation ; Pharmacology. Drug treatments ; preemptive therapy ; Prevention and actions ; Prospective Studies ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Risk Factors ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Transplants & implants ; Valganciclovir</subject><ispartof>American journal of transplantation, 2013-09, Vol.13 (9), p.2402-2410</ispartof><rights>Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons</rights><rights>2014 INIST-CNRS</rights><rights>Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4518-88c3b4cbaf29929dd5d5d5ddf1fe25998c98f68db567b2c92782559c870202573</citedby><cites>FETCH-LOGICAL-c4518-88c3b4cbaf29929dd5d5d5ddf1fe25998c98f68db567b2c92782559c870202573</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fajt.12388$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fajt.12388$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27864155$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23914796$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Manuel, O.</creatorcontrib><creatorcontrib>Kralidis, G.</creatorcontrib><creatorcontrib>Mueller, N. J.</creatorcontrib><creatorcontrib>Hirsch, H. H.</creatorcontrib><creatorcontrib>Garzoni, C.</creatorcontrib><creatorcontrib>van Delden, C.</creatorcontrib><creatorcontrib>Berger, C.</creatorcontrib><creatorcontrib>Boggian, K.</creatorcontrib><creatorcontrib>Cusini, A.</creatorcontrib><creatorcontrib>Koller, M. T.</creatorcontrib><creatorcontrib>Weisser, M.</creatorcontrib><creatorcontrib>Pascual, M.</creatorcontrib><creatorcontrib>Meylan, P. R.</creatorcontrib><creatorcontrib>Swiss Transplant Cohort Study</creatorcontrib><title>Impact of Antiviral Preventive Strategies on the Incidence and Outcomes of Cytomegalovirus Disease in Solid Organ Transplant Recipients</title><title>American journal of transplantation</title><addtitle>Am J Transplant</addtitle><description>We assessed the impact of antiviral prophylaxis and preemptive therapy on the incidence and outcomes of cytomegalovirus (CMV) disease in a nationwide prospective cohort of solid organ transplant recipients. Risk factors associated with CMV disease and graft failure‐free survival were analyzed using Cox regression models. One thousand two hundred thirty‐nine patients transplanted from May 2008 until March 2011 were included; 466 (38%) patients received CMV prophylaxis and 522 (42%) patients were managed preemptively. Overall incidence of CMV disease was 6.05% and was linked to CMV serostatus (D+/R− vs. R+, hazard ratio [HR] 5.36 [95% CI 3.14–9.14], p < 0.001). No difference in the incidence of CMV disease was observed in patients receiving antiviral prophylaxis as compared to the preemptive approach (HR 1.16 [95% CI 0.63–2.17], p = 0.63). CMV disease was not associated with a lower graft failure‐free survival (HR 1.27 [95% CI 0.64–2.53], p = 0.50). Nevertheless, patients followed by the preemptive approach had an inferior graft failure‐free survival after a median of 1.05 years of follow‐up (HR 1.63 [95% CI 1.01–2.64], p = 0.044). The incidence of CMV disease in this cohort was low and not influenced by the preventive strategy used. However, patients on CMV prophylaxis were more likely to be free from graft failure.
In this nationwide cohort of solid organ transplant recipients, the authors find that the incidence of cytomegalovirus disease is similar irrespective of the antiviral preventive strategy used (preemptive vs. prophylaxis), although patients who received antiviral prophylaxis have better graft failure‐free survival.</description><subject>Adult</subject><subject>Aged</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Antiviral agents</subject><subject>Antiviral Agents - therapeutic use</subject><subject>Antiviral prophylaxis</subject><subject>Biological and medical sciences</subject><subject>Cytomegalovirus</subject><subject>Cytomegalovirus Infections - epidemiology</subject><subject>Cytomegalovirus Infections - prevention & control</subject><subject>Disease prevention</subject><subject>Female</subject><subject>Ganciclovir - analogs & derivatives</subject><subject>Ganciclovir - therapeutic use</subject><subject>graft loss</subject><subject>Graft Survival</subject><subject>Herpesviridae</subject><subject>Humans</subject><subject>Incidence</subject><subject>indirect effects</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Organ Transplantation</subject><subject>Pharmacology. Drug treatments</subject><subject>preemptive therapy</subject><subject>Prevention and actions</subject><subject>Prospective Studies</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Risk Factors</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Transplants & implants</subject><subject>Valganciclovir</subject><issn>1600-6135</issn><issn>1600-6143</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqN0d1qFDEUAOAgFlurF76ABESoF9vmZzKTXC5rtVsKFbteD5nMyZplJjMmmco-ga9ttrutIAgmFzkhH-ckOQi9oeSc5nGhN-mcMi7lM3RCS0JmJS3486eYi2P0MsYNIbRikr1Ax4wrWlSqPEG_lv2oTcKDxXOf3L0LusNfAtzDbgf4LgWdYO0g4sHj9B3w0hvXgjeAtW_x7ZTM0O9OLV5sUw7Xuhtyminijy6CjoCdx3dD5zIOa-3xKmgfx077hL-CcaPLpeIrdGR1F-H1YT1F3z5drhZXs5vbz8vF_GZmCkHlTErDm8I02jKlmGpb8TBbSy0woZQ0StpSto0oq4YZxSrJhFBGVoQRJip-is72eccw_Jggprp30UCXrwPDFOv8cYrRiovifyhnFS-IzPTdX3QzTMHnh2TFZMkKVpRZfdgrE4YYA9h6DK7XYVtTUu8aWedG1g-NzPbtIePU9NA-ycfOZfD-AHQ0urP5U42Lf1wly4IKkd3F3v10HWz_XbGeX6_2pX8Do7W0XA</recordid><startdate>201309</startdate><enddate>201309</enddate><creator>Manuel, O.</creator><creator>Kralidis, G.</creator><creator>Mueller, N. J.</creator><creator>Hirsch, H. H.</creator><creator>Garzoni, C.</creator><creator>van Delden, C.</creator><creator>Berger, C.</creator><creator>Boggian, K.</creator><creator>Cusini, A.</creator><creator>Koller, M. T.</creator><creator>Weisser, M.</creator><creator>Pascual, M.</creator><creator>Meylan, P. R.</creator><general>Wiley</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>7U1</scope><scope>7U2</scope><scope>C1K</scope></search><sort><creationdate>201309</creationdate><title>Impact of Antiviral Preventive Strategies on the Incidence and Outcomes of Cytomegalovirus Disease in Solid Organ Transplant Recipients</title><author>Manuel, O. ; Kralidis, G. ; Mueller, N. J. ; Hirsch, H. H. ; Garzoni, C. ; van Delden, C. ; Berger, C. ; Boggian, K. ; Cusini, A. ; Koller, M. T. ; Weisser, M. ; Pascual, M. ; Meylan, P. R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4518-88c3b4cbaf29929dd5d5d5ddf1fe25998c98f68db567b2c92782559c870202573</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Antibiotics. Antiinfectious agents. Antiparasitic agents</topic><topic>Antiviral agents</topic><topic>Antiviral Agents - therapeutic use</topic><topic>Antiviral prophylaxis</topic><topic>Biological and medical sciences</topic><topic>Cytomegalovirus</topic><topic>Cytomegalovirus Infections - epidemiology</topic><topic>Cytomegalovirus Infections - prevention & control</topic><topic>Disease prevention</topic><topic>Female</topic><topic>Ganciclovir - analogs & derivatives</topic><topic>Ganciclovir - therapeutic use</topic><topic>graft loss</topic><topic>Graft Survival</topic><topic>Herpesviridae</topic><topic>Humans</topic><topic>Incidence</topic><topic>indirect effects</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Organ Transplantation</topic><topic>Pharmacology. Drug treatments</topic><topic>preemptive therapy</topic><topic>Prevention and actions</topic><topic>Prospective Studies</topic><topic>Public health. Hygiene</topic><topic>Public health. 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R.</creatorcontrib><creatorcontrib>Swiss Transplant Cohort Study</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>Environmental Sciences and Pollution Management</collection><jtitle>American journal of transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Manuel, O.</au><au>Kralidis, G.</au><au>Mueller, N. J.</au><au>Hirsch, H. H.</au><au>Garzoni, C.</au><au>van Delden, C.</au><au>Berger, C.</au><au>Boggian, K.</au><au>Cusini, A.</au><au>Koller, M. T.</au><au>Weisser, M.</au><au>Pascual, M.</au><au>Meylan, P. R.</au><aucorp>Swiss Transplant Cohort Study</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Antiviral Preventive Strategies on the Incidence and Outcomes of Cytomegalovirus Disease in Solid Organ Transplant Recipients</atitle><jtitle>American journal of transplantation</jtitle><addtitle>Am J Transplant</addtitle><date>2013-09</date><risdate>2013</risdate><volume>13</volume><issue>9</issue><spage>2402</spage><epage>2410</epage><pages>2402-2410</pages><issn>1600-6135</issn><eissn>1600-6143</eissn><abstract>We assessed the impact of antiviral prophylaxis and preemptive therapy on the incidence and outcomes of cytomegalovirus (CMV) disease in a nationwide prospective cohort of solid organ transplant recipients. Risk factors associated with CMV disease and graft failure‐free survival were analyzed using Cox regression models. One thousand two hundred thirty‐nine patients transplanted from May 2008 until March 2011 were included; 466 (38%) patients received CMV prophylaxis and 522 (42%) patients were managed preemptively. Overall incidence of CMV disease was 6.05% and was linked to CMV serostatus (D+/R− vs. R+, hazard ratio [HR] 5.36 [95% CI 3.14–9.14], p < 0.001). No difference in the incidence of CMV disease was observed in patients receiving antiviral prophylaxis as compared to the preemptive approach (HR 1.16 [95% CI 0.63–2.17], p = 0.63). CMV disease was not associated with a lower graft failure‐free survival (HR 1.27 [95% CI 0.64–2.53], p = 0.50). Nevertheless, patients followed by the preemptive approach had an inferior graft failure‐free survival after a median of 1.05 years of follow‐up (HR 1.63 [95% CI 1.01–2.64], p = 0.044). The incidence of CMV disease in this cohort was low and not influenced by the preventive strategy used. However, patients on CMV prophylaxis were more likely to be free from graft failure.
In this nationwide cohort of solid organ transplant recipients, the authors find that the incidence of cytomegalovirus disease is similar irrespective of the antiviral preventive strategy used (preemptive vs. prophylaxis), although patients who received antiviral prophylaxis have better graft failure‐free survival.</abstract><cop>Hoboken, NJ</cop><pub>Wiley</pub><pmid>23914796</pmid><doi>10.1111/ajt.12388</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adult Aged Antibiotics. Antiinfectious agents. Antiparasitic agents Antiviral agents Antiviral Agents - therapeutic use Antiviral prophylaxis Biological and medical sciences Cytomegalovirus Cytomegalovirus Infections - epidemiology Cytomegalovirus Infections - prevention & control Disease prevention Female Ganciclovir - analogs & derivatives Ganciclovir - therapeutic use graft loss Graft Survival Herpesviridae Humans Incidence indirect effects Male Medical sciences Middle Aged Organ Transplantation Pharmacology. Drug treatments preemptive therapy Prevention and actions Prospective Studies Public health. Hygiene Public health. Hygiene-occupational medicine Risk Factors Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Transplants & implants Valganciclovir |
| title | Impact of Antiviral Preventive Strategies on the Incidence and Outcomes of Cytomegalovirus Disease in Solid Organ Transplant Recipients |
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