Thymoglobulin (ATG) used as induction therapy is considered a risk factor for CMV disease in renal transplantation (RTx) and prophylaxis is recommended. Our center policy is ganciclovir and/or valGCV prophylaxis for 90 days. However, the outcome of this policy it is not clear. All RTx in CMV-seropositive adults (≥18y) (Jan07-Dec14) with ATG (6mg/kg) as induction therapy (n=544) were evaluated using our electronic database. In 65 patients, there were no clear data on prophylaxis duration and they were discarded. Graft losses/death before day 19 (n=7) were also excluded. 472 patients, receiving tacrolimus/MPA and steroids but not mTORi, were analyzed. Prophylaxis was defined as started up to the 7^th day with at least for 14 days of medication. CMV disease (CMVd) was considered present if it occurred up to the 2^nd year after TX. Two cases with very late episodes (1220 and 2341 days) were not considered CMVd. CMVd was diagnosed when clinically suspected along with a positive PCR/DNAemia or biopsy. 73 patients developed CMVd (17% by Kaplan Meier) and 399 did not. CMVd occurred at a later time after RTx (160±85 days) and in 95% (69 cases) before day 300. 60 CMVd (82%) were syndrome and 13 (18%) invasive disease (12 G-I and 1 encephalitis). There was no difference in the length of prophylaxis in patients with and without CMVd (78±29 vs74±33 days, respectively). These groups also did not differ in terms of demographics, transplant features and immunosuppressive drugs. At a mean follow-up of 945 days, patient and graft survival did not differ between patients with and without CMVd but eGFR (MDRD4) at last f-up was lower in the CMVd group (44±20 vs 51±21 ml/min/1.73m2, p=0.013). Acute rejection (AR) occurred more frequently in patients with CMVd (45% vs 25%, p<0.001). 13 (18%) patients developed AR after CMVd (median +186 days (64-675) and 22 (30%) before CMVd(-117±87days) being 10 AMR (3 treated with ATG and 1 with rituximab. IVIG and plasmapheresis were the main treatments) and 12 ACR (treated with methylprednisolone). These data indicate that CMV prophylaxis seems to reduce CMV disease rate in seropositive patients using ATG as induction therapy. Nevertheless, CMVd develops in 17% of these cases after prophylaxis is withdrawn. Therefore, either the extension of the prophylaxis period or CMV monitoring up to 300 days, for preemptive treatment, should be performed in order to avoid late CMV disease.

CITATION INFORMATION: Feitosa E, Agena F, Reusing Jr J, Lemos F, David-Neto E. Is CMV Prophylaxis Effective in CMV-Seropositive Patients Receiving Thymoglobulin as Induction Therapy? Am J Transplant. 2016;16 (suppl 3).

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