The current burden of cytomegalovirus infection in kidney transplant recipients receiving no pharmacological prophylaxis
Abstract Cytomegalovirus (CMV) infection in kidney transplantation has changed its clinical spectrum, mostly due to the current and more effective immunosuppression. In the absence of preventive strategies it is associated with significant morbi-mortality. Objective: This study evaluated the incidence of CMV events and its effect on outcomes of kidney transplantation in recipients without pharmacological prophylaxis or targeted preemptive treatment. Results: The study cohort comprised 802 recipients of kidney transplants between 04/30/2014 and 04/30/2015. The majority received induction with anti-thymocyte globulin (81.5%), tacrolimus and prednisone in combination with either mycophenolate (46.3%) or azathioprine (53.7%). The overall incidence of CMV events was 42% (58.6% infection and 41.4% disease). Patients with CMV showed higher incidence of first treated acute rejection (19 vs. 11%, p = 0,001) compared with those without CMV but no differences in graft loss, death or loss to follow-up. The incidence of delayed graft function was higher (56% vs. 37%, p = 0.000) and the eGFR at 1 (41 ± 21 vs. 54 ± 28 ml/min, p = 0.000) and 12 months (50 ± 19 vs. 61 ± 29 ml/min, p = 0.000) were lower in patients with CMV. Recipients age (OR = 1.03), negative CMV serology (OR = 5.21) and use of mycophenolate (OR = 1.67) were associated with increased risk of CMV. Changes in immunosuppression was more often in patients with CMV (63% vs. 31%, p = 0.000). Conclusion: the incidence of CMV events was high and associated with higher incidence of acute rejection and changes in immunosuppression. Besides traditional risk factors, renal function at 1 month was independently associated with CMV infection.
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Sociedade Brasileira de Nefrologia
2017
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oai:scielo:S0101-280020170004004132018-01-04The current burden of cytomegalovirus infection in kidney transplant recipients receiving no pharmacological prophylaxisFelipe,Claudia RossoFerreira,Alexandra NicolauBessa,AdrieliAbait,TamirisRuppel,PriscillaPaula,Mayara Ivani deHiramoto,LilianeViana,LailaMartins,SuelenCristelli,MarinaAguiar,WilsonMansur,JulianaBasso,GeovanaSilva Junior,Helio TedescoPestana,Jose Medina cytomegalovirus kidney transplantation immunosuppression Abstract Cytomegalovirus (CMV) infection in kidney transplantation has changed its clinical spectrum, mostly due to the current and more effective immunosuppression. In the absence of preventive strategies it is associated with significant morbi-mortality. Objective: This study evaluated the incidence of CMV events and its effect on outcomes of kidney transplantation in recipients without pharmacological prophylaxis or targeted preemptive treatment. Results: The study cohort comprised 802 recipients of kidney transplants between 04/30/2014 and 04/30/2015. The majority received induction with anti-thymocyte globulin (81.5%), tacrolimus and prednisone in combination with either mycophenolate (46.3%) or azathioprine (53.7%). The overall incidence of CMV events was 42% (58.6% infection and 41.4% disease). Patients with CMV showed higher incidence of first treated acute rejection (19 vs. 11%, p = 0,001) compared with those without CMV but no differences in graft loss, death or loss to follow-up. The incidence of delayed graft function was higher (56% vs. 37%, p = 0.000) and the eGFR at 1 (41 ± 21 vs. 54 ± 28 ml/min, p = 0.000) and 12 months (50 ± 19 vs. 61 ± 29 ml/min, p = 0.000) were lower in patients with CMV. Recipients age (OR = 1.03), negative CMV serology (OR = 5.21) and use of mycophenolate (OR = 1.67) were associated with increased risk of CMV. Changes in immunosuppression was more often in patients with CMV (63% vs. 31%, p = 0.000). Conclusion: the incidence of CMV events was high and associated with higher incidence of acute rejection and changes in immunosuppression. Besides traditional risk factors, renal function at 1 month was independently associated with CMV infection.info:eu-repo/semantics/openAccessSociedade Brasileira de NefrologiaBrazilian Journal of Nephrology v.39 n.4 20172017-12-01info:eu-repo/semantics/articletext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002017000400413en10.5935/0101-2800.20170074 |
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Felipe,Claudia Rosso Ferreira,Alexandra Nicolau Bessa,Adrieli Abait,Tamiris Ruppel,Priscilla Paula,Mayara Ivani de Hiramoto,Liliane Viana,Laila Martins,Suelen Cristelli,Marina Aguiar,Wilson Mansur,Juliana Basso,Geovana Silva Junior,Helio Tedesco Pestana,Jose Medina |
| spellingShingle |
Felipe,Claudia Rosso Ferreira,Alexandra Nicolau Bessa,Adrieli Abait,Tamiris Ruppel,Priscilla Paula,Mayara Ivani de Hiramoto,Liliane Viana,Laila Martins,Suelen Cristelli,Marina Aguiar,Wilson Mansur,Juliana Basso,Geovana Silva Junior,Helio Tedesco Pestana,Jose Medina The current burden of cytomegalovirus infection in kidney transplant recipients receiving no pharmacological prophylaxis |
| author_facet |
Felipe,Claudia Rosso Ferreira,Alexandra Nicolau Bessa,Adrieli Abait,Tamiris Ruppel,Priscilla Paula,Mayara Ivani de Hiramoto,Liliane Viana,Laila Martins,Suelen Cristelli,Marina Aguiar,Wilson Mansur,Juliana Basso,Geovana Silva Junior,Helio Tedesco Pestana,Jose Medina |
| author_sort |
Felipe,Claudia Rosso |
| title |
The current burden of cytomegalovirus infection in kidney transplant recipients receiving no pharmacological prophylaxis |
| title_short |
The current burden of cytomegalovirus infection in kidney transplant recipients receiving no pharmacological prophylaxis |
| title_full |
The current burden of cytomegalovirus infection in kidney transplant recipients receiving no pharmacological prophylaxis |
| title_fullStr |
The current burden of cytomegalovirus infection in kidney transplant recipients receiving no pharmacological prophylaxis |
| title_full_unstemmed |
The current burden of cytomegalovirus infection in kidney transplant recipients receiving no pharmacological prophylaxis |
| title_sort |
current burden of cytomegalovirus infection in kidney transplant recipients receiving no pharmacological prophylaxis |
| description |
Abstract Cytomegalovirus (CMV) infection in kidney transplantation has changed its clinical spectrum, mostly due to the current and more effective immunosuppression. In the absence of preventive strategies it is associated with significant morbi-mortality. Objective: This study evaluated the incidence of CMV events and its effect on outcomes of kidney transplantation in recipients without pharmacological prophylaxis or targeted preemptive treatment. Results: The study cohort comprised 802 recipients of kidney transplants between 04/30/2014 and 04/30/2015. The majority received induction with anti-thymocyte globulin (81.5%), tacrolimus and prednisone in combination with either mycophenolate (46.3%) or azathioprine (53.7%). The overall incidence of CMV events was 42% (58.6% infection and 41.4% disease). Patients with CMV showed higher incidence of first treated acute rejection (19 vs. 11%, p = 0,001) compared with those without CMV but no differences in graft loss, death or loss to follow-up. The incidence of delayed graft function was higher (56% vs. 37%, p = 0.000) and the eGFR at 1 (41 ± 21 vs. 54 ± 28 ml/min, p = 0.000) and 12 months (50 ± 19 vs. 61 ± 29 ml/min, p = 0.000) were lower in patients with CMV. Recipients age (OR = 1.03), negative CMV serology (OR = 5.21) and use of mycophenolate (OR = 1.67) were associated with increased risk of CMV. Changes in immunosuppression was more often in patients with CMV (63% vs. 31%, p = 0.000). Conclusion: the incidence of CMV events was high and associated with higher incidence of acute rejection and changes in immunosuppression. Besides traditional risk factors, renal function at 1 month was independently associated with CMV infection. |
| publisher |
Sociedade Brasileira de Nefrologia |
| publishDate |
2017 |
| url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002017000400413 |
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