COMPLICATIONS - INFECTIONS

D. Cantarovich, F. Leone, A. Akl, M. Giral, J. Dantal, G. Blancho, J. Soulillou
Nephrology And Transplantation, ITERT, Nantes/FRANCE

Body: Introduction. Strategies for CMV infection prevention are currently used after kidney transplantation. However, there are no clear guidelines for which drug should be given as first-line selection and how long this prophylaxis should last. Aim. We followed 550 primary single kidney transplant recipients in an observational cohort analysis to evaluate the impact of 3 consecutive different CMV prevention strategies within 12 years. Methods. Period 1 (1996–2000; n=190, 51% males, mean age 51±13 yr), no anti-CMV prophylaxis was given and IV ganciclovir was used for CMV infection treatment; period 2 (2000–2004; n=173, 66%males, mean age 53±14 yr), 6-month prophylaxis with valacyclovir was given; and period 3 (>2004; n=187, 66%males, mean age 51±15 yr), 6-month prophylaxis with valganciclovir was given. All patients received induction and CNI/MMF/Steroid free maintenance regimen. Thymoglobulin induction was more often given in period 1 and 2 than in period 3 (42%, 43% and 11%, respectively) while Basiliximab induction was less given in period 1 and 2 than in period 3 (35%, 54% and 89%, respectively). Cyclosporin was given to 45% of patients in period 1, 13% in period 2 and 9% in period 3. Tacrolimus was given to 13% of patients in period 1, 40% in period 2 and 75.4% in period 3. MMF was given to all patients in the 3 periods. Cox proportional hazard model was utilized to estimate the risk factors for the development of CMV disease and to assess independent covariates on graft survival. Results. CMV disease significantly decreased from 33.2% in period 1 to 13.9% in period 2 and to 8.6% in period 3. CMV disease onset was significantly prolonged with valganciclovir prophylaxis (228 days) compared to valacyclovir prophylaxis (93 days) and to no prophylaxis at all (33 days). The majority of CMV diseases encountered in both valacyclovir and valganciclovir prophylactic groups were primary infections (79.2 and 93.8%, respectively) as compared to a significant low number (39.7%) in the non prophylaxis group. Two cases of valganciclovir resistance were recorded in the valganciclovir prophylaxis group. A significant reduced incidence of other herpes viruses was only observed in the valganciclovir prophylaxis group. Valganciclovir was better tolerated than valacyclovir and this long-term prophylaxis was applicable to 85% of patients. Cox PH confirmed 3 independent factors for CMV disease: CMV D+/R-, Thymoglobulin induction and anti-CMV prophylaxis with either valacyclovir or valganciclovir, and 2 factors for graft survival: acute and chronic rejection. Similar actuarial graft and patient survivals were observed in the 3 groups throughout follow-up. Conclusion. Both 6-month prophylaxis with valacyclovir or vanganciclovir were efficient in preventing CMV disease as compared to no prophylaxis after kidney transplantation. However, these strategies were less efficient in the D+/R- group and did not improve patient and graft survivals.

Disclosure: All authors have declared no conflicts of interest.