BACKGROUND: 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. MATERIALS AND METHODS: 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. RESULTS: 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). CONCLUSION: Our experience confirms the validity of the pre-emptive anti-CMV therapy in renal transplantation patients.

Pre-emptive therapy for the treatment of cytomegalovirus after kidney transplantation / Pretagostini, R; Poli, L; Lai, Q; Russo, G; Nudo, F; Garofalo, M; Melandro, F; Gaeta, A; Nazzari, C; Fazio, C; Di Simone, E; Vullo, V; Berloco, Pb.. - In: TRANSPLANTATION PROCEEDINGS. - ISSN 0041-1345. - STAMPA. - 49:4(2017), pp. 638-641. [10.1016/j.transproceed.2017.02.019]

Pre-emptive therapy for the treatment of cytomegalovirus after kidney transplantation

Pretagostini R
;
Poli L;Lai Q;Russo G;Nudo F;Garofalo M;Melandro F;Gaeta A;Nazzari C;Fazio C;Di Simone E;Vullo V;Berloco PB.
2017

Abstract

BACKGROUND: 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. MATERIALS AND METHODS: 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. RESULTS: 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). CONCLUSION: Our experience confirms the validity of the pre-emptive anti-CMV therapy in renal transplantation patients.
2017
Antibiotic Prophylaxis, methods*; Antiviral Agents, therapeutic use*; Cytomegalovirus; Cytomegalovirus Infections, epidemiology ;Cytomegalovirus Infections, prevention & control*; Incidence Kidney Transplantation,adverse effects*; Living Donors; Retrospective Studies
01 Pubblicazione su rivista::01a Articolo in rivista
Pre-emptive therapy for the treatment of cytomegalovirus after kidney transplantation / Pretagostini, R; Poli, L; Lai, Q; Russo, G; Nudo, F; Garofalo, M; Melandro, F; Gaeta, A; Nazzari, C; Fazio, C; Di Simone, E; Vullo, V; Berloco, Pb.. - In: TRANSPLANTATION PROCEEDINGS. - ISSN 0041-1345. - STAMPA. - 49:4(2017), pp. 638-641. [10.1016/j.transproceed.2017.02.019]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1087094
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