Pre-Emptive Therapy for the Treatment of Cytomegalovirus After Kidney Transplantation

• DOI: 10.1016/j.transproceed.2017.02.019
• Publication Date: 2017-04-27T11:16:08Z
• Authors: R. Pretagostini; L. Poli; Q. Lai; G. Russo; F. Nudo; M. Garofalo; F. Melandro; A. Gaeta; C. Nazzari; C. Fazio; E. Di Simone; V. Vullo; P.B. Berloco
• Keywords: Cytomegalovirus; Viremia; Betaherpesvirinae

Cytomegalovirus (CMV) represents the leading cause of viral infection in kidney transplantation patients. The aim of the present study was to evaluate the efficacy and safety of pre-emptive anti-CMV therapy.We performed a retrospective analysis based on data from 227 consecutive patients transplanted from 2010 to 2015, of whom 38 (16.6%) were from a living donor, considering: incidence of rejection, CMV organ localization, and graft and patient survival. All patients underwent induction immunosuppressive therapy followed by maintenance therapy consisting of corticosteroids, antimetabolites, and tacrolimus (median basal dose = 5.3 ng/mL). The timing for the detection of plasma CMV-DNA in the post-transplantation period was: weekly (first month), quarterly (second through twelfth month), and then half-yearly.CMV viremia was positive in 98 of 227 (43.1%) patients, with an average of 248,482 copies/mL (range: 250 copies/mL to 9,745,000 copies/mL) and the first positivity after a median period of 2.5 months from kidney transplantation (range: 0.2 months to 43 months). A total of 49 of 227 (21.5%) patients were treated with antivirals: 27 of 49 (55.1%) because of CMV organ localization (gastrointestinal = 20, lungs = 3, kidney = 2, liver = 2). Fourteen of 227 (6.1%) patients had a rejection episode, 7 (3.1%) of which were CMV-related. Fifteen of 227 (6.6%) patients died (noninfectious CMV-related complications = 8, cardiovascular causes = 6, bleeding complications = 1).Our experience confirms the validity of the pre-emptive anti-CMV therapy in renal transplantation patients.