Impact of antiviral preventive strategies on the incidence and outcomes of cytomegalovirus disease in solid organ transplant recipients

Publication

Impact of antiviral preventive strategies on the incidence and outcomes of cytomegalovirus disease in solid organ transplant recipients

Journal Paper/Review - Aug 5, 2013

Manuel O, Meylan P R, Pascual M, Weisser M, Koller M T, Cusini A, Boggian Katia, Berger C, van Delden C, Garzoni C, Hirsch H H, Mueller N J, Kralidis G, Swiss Transplant Cohort Study

Citation

Manuel O, Meylan P, Pascual M, Weisser M, Koller M, Cusini A, Boggian K, Berger C, van Delden C, Garzoni C, Hirsch H, Mueller N, Kralidis G, Swiss Transplant Cohort Study. Impact of antiviral preventive strategies on the incidence and outcomes of cytomegalovirus disease in solid organ transplant recipients. Am J Transplant 2013; 13:2402-10.

Type

Journal Paper/Review (English)

Journal

Am J Transplant 2013; 13

Publication Date

Aug 5, 2013

Issn Electronic

1600-6143

Pages

2402-10

Brief description/objective

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.