A new strategy of delayed long-term prophylaxis could prevent cytomegalovirus disease in (D+/R-) solid organ transplant recipients

Clin Transplant. 2009 Sep-Oct;23(5):666-71. doi: 10.1111/j.1399-0012.2009.01077.x. Epub 2009 Aug 17.

Abstract

Long-term prophylaxis against cytomegalovirus (CMV) started immediately after transplantation in (D+/R-) poses a higher risk of late-onset CMV disease. Delayed CMV prophylaxis could allow a transitory exposure of the immune system to CMV, which would let the immune system mount an adequate CMV-specific cytotoxic response in (D+/R-) patients and confer protection against CMV disease. We included all (D+/R-) solid organ transplant recipients (SOT) performed at our institution (January 3/October 6) who received CMV prophylaxis (mainly with oral valganciclovir) during 100 d. In the first period (until December 4), prophylaxis was initiated immediately after transplantation (conventional prophylaxis: CP). Since January 5, it was initiated after 14 d (delayed prophylaxis: DP). Incidence and severity of CMV disease was compared between both groups. A total of 44 SOT recipients were included (CP: 26 and DP: 18). CMV disease was diagnosed in eight patients (18%), seven of 26 (27%) in the CP group, and one of 18 (5.5%) in the DP group (p = 0.07). CMV colitis was reported in five of 26 patients in the CP group (19%), whereas there were no cases of visceral CMV disease in the DP group (p = 0.048). A 14-d delay in the beginning of long-term prophylaxis against CMV in (D+/R-) is safe and could prevent the onset of late-CMV disease.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antiviral Agents / therapeutic use*
  • Cytomegalovirus / pathogenicity*
  • Cytomegalovirus Infections / prevention & control*
  • Cytomegalovirus Infections / virology
  • Ganciclovir / analogs & derivatives*
  • Ganciclovir / therapeutic use
  • Graft Rejection / immunology*
  • Humans
  • Organ Transplantation*
  • Prognosis
  • Risk Factors
  • Survival Rate
  • Transplantation Immunology*
  • Treatment Outcome
  • Valganciclovir

Substances

  • Antiviral Agents
  • Valganciclovir
  • Ganciclovir