2010 - TTS International Congress


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CMV Infection

90.6 - Monitoring with or without Pre-emptive Therapy versus Prophylaxis for Cytomegalovirus (CMV) in Renal Transplant Patients

Presenter: Jacob, Akoh, Plymouth,
Authors: Rana T., Taylor J., Akoh J.

MONITORING WITH OR WITHOUT PRE-EMPTIVE THERAPY VERSUS PROPHYLAXIS FOR CYTOMEGALOVIRUS (CMV) IN RENAL TRANSPLANT PATIENTS

CMV INFECTION

T.A.K. Rana, J. Taylor, J.A. Akoh
Surgery & Renal Services, Plymouth Hospitals NHS Trust, Plymouth/UNITED KINGDOM

Body: Introduction: Before 2007, CMV monitoring ± pre-emptive therapy in at-risk renal transplant patients (positive donor to negative recipient [DP-RN]) was the policy at our centre. A comprehensive review of patients undergoing renal transplantation between April 2002 and March 2006 (Group1) revealed a high rate of CMV infection and the practice was changed to CMV prophylaxis in at-risk patients (Group2). This study compares the incidence of CMV infection and disease between the two groups. Methods: Group1 consists of 99 transplants from April 2002 to March 2006. Immunosuppression comprised induction with Basiliximab (high risk), Ciclosporin or Tacrolimus, Azathiaprine and Prednisolone. These patients had regular weekly PCR measured viral titres and CMV treatment started when the viral load was ≥ log10 3.7 (5000 copies/ml). Group2 comprised all transplants in 2007 and 2008. Immunosuppression comprised induction with Basiliximab, Tacrolimus, Mycophenolic acid and Prednisolone. Following 3 months of prophylactic Valganciclovir at a dose of 450 mg daily or equivalent dose based on renal function, CMV monitoring was performed fortnightly for 2 months and monthly for 2 months or longer if the patient developed symptoms. CMV infection was diagnosed when the viral load was ≥ Log10 3.7 and CMV disease in patients with titres ≥ Log10 5 (100,000 copies per ml). CMV disease was treated with Valganciclovir 900mg twice daily if normal renal function until CMV viral load became negative. Data regarding donor and recipient CMV status, receipt of prophylaxis, dose of Valganciclovir, duration of prophylaxis, CMV titres and interval from transplantation to CMV infection or disease was recorded prospectively into a renal database (Proton). Data was retrieved from patients’ notes and Proton entered into an MS Excel spreadsheet and analysed. Results: Twenty nine of 99 patients in Group1 and 39 of 133 in group were high risk for CMV. The incidence of significant CMV infection and disease among the groups is shown in Table 1. Overall the prophylaxis group had statistically significantly lower CMV infection and disease rates. In spite of pre-emptive therapy, 11 of 17 (65 %) patients with a viral load of 5000 copies/ml developed CMV disease. For Group2 patients, the median interval from transplantation to CMV infection was 4.2 months and to CMV disease 7 months. Conclusion: Antiviral prophylaxis significantly reduces the incidence of CMV infection and disease and prolongs the disease free interval after renal transplantation. There is a need to re-examine the duration of CMV prophylaxis as the median interval for CMV infection is about 4 months after transplantation. Table 1: Incidence of CMV infection and disease in high risk patients following renal transplantation

CMV Monitoring (Group1) CMV Prophylaxis (Group2) Chi-square with Yates correction p-value
Number 99 133
High risk for CMV (DP-RN) 29 39
CMV Infection (≥ Log10 3.7) 17 (59%) 11 (28%) 5.159 0.0231
CMV Disease (≥ Log10 5.0) 11 (38%) 4 (10%) 5.887 0.0153


Disclosure: All authors have declared no conflicts of interest.


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