Impact of Antiviral Preventive Strategies on the Incidence and Outcomes of Cytomegalovirus Disease in Solid-Organ Transplant Recipients
CHUV, Lausanne
, Basel
, Zurich
, Bern
, Geneva
, St Gallen, Switzerland
Meeting: 2013 American Transplant Congress
Abstract number: A578
Background: Antiviral prophylaxis and preemptive therapy are currently used for preventing cytomegalovirus (CMV) disease in solid-organ transplant (SOT) recipients. However, both approaches have not been compared in prospective multicenter studies. We assessed the impact of both strategies on the incidence and outcomes of CMV disease in a nationwide prospective cohort of SOT recipients.
Methods: Patients participating in the Swiss Transplant Cohort Study (STCS) and transplanted from 5/2008 until 3/2011 were included. Risk factors associated with CMV disease and graft failure-free survival were analyzed using Cox regression models treating death as competing risk.
Results: 1239 patients were included; 466 (38%) patients had received CMV prophylaxis and 522 (42%) patients were treated preemptively. There were 83 episodes of CMV disease in 75 patients (6%), with 13 episodes of proven end-organ disease. CMV disease incidence was linked to CMV serostatus (D+/R-vs. R+, hazard ratio [HR] 5.18 [95% CI 3.04 – 8.81], p<0.001). After excluding patients with missing serostatus, no difference in the incidence of CMV disease was observed between patients in the prophylactic or the preemptive approach (HR 1.20 [95% CI 0.65 – 2.23], p=0.56) overall, or in the high risk D+/R- (HR 1.96 [95% CI 0.85 – 4.54], p=0.12) or intermediate risk R+ groups (HR 0.34 [95% CI 0.10 – 1.16], p=0.09), even though prophylaxis delayed CMV disease. CMV disease was not associated with a lower graft failure-free survival (HR 1.32 [95% CI 0.66 – 2.63], p= 0.44). However, patients managed by the preemptive approach had an inferior graft failure-free survival after a median of 1.05 years of follow-up (HR 1.63 [95% CI 1.01-2.63], p=0.044).
Conclusions: The overall incidence of CMV disease in this nationwide cohort was low and not influenced by the preventive strategy used. However, patients on CMV prophylaxis had better graft survival.
Manuel, O.: Grant/Research Support, Roche.
To cite this abstract in AMA style:
Manuel O, Kralidis G, Mueller N, Hirsch H, Garzoni C, Delden CVan, Berger C, Boggian K, Cusini A, Koller M, Weisser M, Pascual M, Meylan P, STCS the. Impact of Antiviral Preventive Strategies on the Incidence and Outcomes of Cytomegalovirus Disease in Solid-Organ Transplant Recipients [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/impact-of-antiviral-preventive-strategies-on-the-incidence-and-outcomes-of-cytomegalovirus-disease-in-solid-organ-transplant-recipients/. Accessed May 21, 2025.« Back to 2013 American Transplant Congress