Prophylaxis and Treatment of Cytomegalovirus Infection Postrenal Transplantation in Two Madrid Units

Abstract Introduction Complete prevention of cytomegalovirus (CMV) disease continues to be an unresolved problem in renal transplantation. Materials and Methods From January 2005 to May 2006, we implemented a protocol for early detection and preemptive treatment of CMV infection as detected by antig...

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Bibliographic Details
Published in:Transplantation proceedings 2009-07, Vol.41 (6), p.2416-2418, Article 2416
Main Authors: Fernández, A, Amezquita, Y, Fernández-Tagarro, E, Escuin, F, Jiménez, C, Sánchez Villanueva, R, Galeano, C, Pascual, J, Marcén, R
Format: Article
Language:English
Subjects:
Adult
Aged
Antiviral Agents - therapeutic use
Biological and medical sciences
Blood Chemical Analysis
Cytomegalovirus - physiology
Cytomegalovirus Infections - drug therapy
Cytomegalovirus Infections - prevention & control
Female
Fundamental and applied biological sciences. Psychology
Fundamental immunology
Ganciclovir - analogs & derivatives
Ganciclovir - therapeutic use
Humans
Infectious diseases
Kidney Function Tests
Kidney Transplantation - adverse effects
Liver Function Tests
Male
Medical sciences
Middle Aged
Monitoring, Physiologic
Spain
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Tissue, organ and graft immunology
Viral diseases
Viral Load
Virus Activation
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Summary:Abstract Introduction Complete prevention of cytomegalovirus (CMV) disease continues to be an unresolved problem in renal transplantation. Materials and Methods From January 2005 to May 2006, we implemented a protocol for early detection and preemptive treatment of CMV infection as detected by antigenemia or polymerase chain reaction determined every 2 weeks during the first 3 months posttransplant and monthly thereafter. Prophylaxis was given to all CMV-negative patients who received CMV-positive kidneys and to those who received polyclonal or monoclonal antibody induction therapy. Results Among 100 transplants, 15 subjects received prophylaxis due to poly- or monoclonal antibody induction and/or negative recipient serology using a mean valgancyclovir dose of 485 ± 276 mg/d for an average duration of 129 days. After completion of the prophylaxis four patients (26.6%) required preemptive therapy for asymptomatic virus reactivation; the mean dose of drug in these patients had been 450 ± 275.56 mg, with a treatment time that was significantly shorter than those not suffering reactivation (91.75 vs 143.45 days). In addition, preemptive therapy was given for virus reactivation in seven patients, for illness with mild viral syndrome in two, with moderate illness and positive pretransplantation serology in one. The average treatment time was 79 days and the mean dose was 375 mg. Conclusion In those not at risk, CMV infections occurred among 11.7% of patients in our early detection program. Prophylaxis for at-risk patients should continue for more than 3 months to prevent reactivation.
ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2009.06.161