Background: Although much is known about the incidence and prevention strategies in CMV-seronegative KT recipients, there is comparatively little information on these issues in CMV-seropositive patients.
Methods: From May 2011 to April 2012 a total of 287 CMV-seropositive KT recipients were included in a multicenter, prospective, cohort study conducted in 21 Spanish centers. The minimum follow-up period was 6 months. The primary study outcome was the incidence of CMV disease (viral syndrome or tissue-invasive disease) at months 3 and 6. A number of pre-transplant, perioperative, and post-transplant variables were prospectively recorded in a computerized database. We specifically analyzed the incidence of CMV disease in different groups: preemptive treatment (PT) or prophylaxis.
Results: At baseline, 126 patients (43.9%) were managed by PT, 124 (43.2%) by prophylaxis, and 37 (12.9%) underwent no specific prevention approach. Seven centers (33.3%) did not use PT, and one center (4.7%) did not perform any strategy. On multivariate analysis, the use of prophylaxis was associated with induction with polyclonal antibodies (odds ratio ∨: 38.33; 95% confidence interval [CI]: 10.99-133.63), previous KT (OR: 6.84; 95%CI: 1.22-38.29) and recipient age ≥65 years (OR: 6.60; 95%CI: 2.66-16.39). Prophylaxis were administered for <3 (17.7%), 3 (59.7%) or 6 months (22.6%). Cumulative incidences of CMV disease at months 3 and 6 were 2.4% (7 patients) and 4.2% (12 patients), respectively. According to the baseline strategy, cumulative incidences at month 3 in the prophylaxis and PT groups were 0% and 4.0%, respectively (unadjusted OR [uOR]: 0.49; 95%CI: 0.43-0.56). Cumulative incidences at month 6 in the prophylaxis and PT groups were 1.6% and 5.3% (P = 0.112). There were no significant differences according to the duration of prophylaxis (3- or 6-month regimens). Diabetic nephropathy was associated with CMV disease at month 6 (uOR: 5.23; 95%CI: 1.47-18.64). Among the 70 patients receiving polyclonal antibodies within first 15 days, 62 (89.9%) were managed by prophylaxis and 7 (10.1%) by PT, with only one case of disease (1.4%) in the prophylaxis group.
Conclusions: Prophylaxis strategy was associated with a lower incidence of CMV disease in a large cohort of CMV-seropositive KT recipients.
To cite this abstract in AMA style:Aguado J, Fernández-Ruiz M, Arias M, Campistol J. Epidemiology and Prevention Approaches for Cytomegalovirus (CMV) Disease in CMV-Seropositive Kidney Transplant (KT) Recipients: Results from a Multicenter, Prospective, Cohort Study (OPERA Study) [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/epidemiology-and-prevention-approaches-for-cytomegalovirus-cmv-disease-in-cmv-seropositive-kidney-transplant-kt-recipients-results-from-a-multicenter-prospective-cohort-study-opera-study/. Accessed October 20, 2020.
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