Persisting Gaps in Cytomegalovirus Prevention and Management After Solid Organ Transplantation in a Resource‐Limited Setting

• Published in: Transplant infectious disease Vol. 27; no. 2; pp. e14440 - n/a
• Main Authors: Santoro‐Lopes, Guilherme, Guimarães, Luiz Felipe Abreu, Clemente, Wanessa Trindade, Stucchi, Raquel Silveira Bello, Abdala, Edson, Santos, Daniel Wagner de Castro Lima, Ferreira, Gustavo Fernandes, Haddad, Luciana Bertocco Paiva, Pierrotti, Ligia Camera
• Format: Journal Article
• Language: English
• Published: Denmark Wiley Subscription Services, Inc 01.03.2025
• Subjects: Adult; Antiviral Agents - administration & dosage; Antiviral Agents - therapeutic use; Brazil; Cross-Sectional Studies; Cytomegalovirus; Cytomegalovirus - drug effects; Cytomegalovirus - isolation & purification; Cytomegalovirus Infections - drug therapy; Cytomegalovirus Infections - prevention & control; Cytomegalovirus Infections - virology; Disease prevention; Female; Ganciclovir; Ganciclovir - analogs & derivatives; Ganciclovir - therapeutic use; Humans; Infections; Male; Middle Aged; Organ Transplantation - adverse effects; Preempting; Prophylaxis; Resource-Limited Settings; survey; Surveys and Questionnaires; therapy; Transplantation; Transplants & implants; Valganciclovir; Brazil; survey; cytomegalovirus; prophylaxis; therapy; transplantation
• ISSN: 1398-2273; 1399-3062; 1399-3062
• DOI: 10.1111/tid.14440

ABSTRACT Background Cytomegalovirus (CMV) infection remains among the leading complications after solid organ transplantation (SOT). Large international surveys mainly focused on high‐income countries, detected considerable variability in the management of this infection after SOT. Limited data are available from resource‐limited settings. Methods A questionnaire‐based cross‐sectional study was performed. All transplant programs (TP) registered at the Brazilian Organ Transplantation Society (ABTO) were invited to participate. Results Sixty‐one TP participated in the study. Of these, 59 (97%) reported using at least 1 preventive strategy (prophylaxis or preemptive therapy [PET]). Prophylaxis was reported by only 39 (64%). PET was used by 52 (85%), predominantly for R+ recipients (n = 42/61; 70%). CMV monitoring was performed weekly in only 22 of 52 (42%) TP. This was significantly more common in TP reporting turnaround times ≤72 h for quantitative nuclear acid amplification tests (p < 0.001). Intravenous (IV) ganciclovir was the predominant drug chosen for prophylaxis (21/39 TP; 54%) and for PET (44/52 TP; 77%). Lack of regular access to valganciclovir was significantly associated with the choice of IV ganciclovir for prophylaxis and PET (p = 0.002 for both comparisons). Only 8 (13%) TP had access to molecular diagnostic tests for ganciclovir resistance, and 14 (23%) had access to effective therapy for highly resistant infections. Conclusion These results suggest that strategies to improve the management of CMV after SOT in such a resource‐limited setting are needed and should include not only targeted educational programs but also initiatives to tackle economic and structural barriers. There was considerable variability regarding CMV prevention and management practices, with some divergence from contemporary guidelines. Our results suggest that adhesion to state‐of‐art practices was hampered, in this large resource‐limited setting, by economic and structural issues, which included the lack of access to appropriate laboratorial support and antiviral drugs.