Patterns of cytomegalovirus infection in simultaneous kidney-pancreas transplant recipients receiving tacrolimus, mycophenolate mofetil, and prednisone with ganciclovir prophylaxis

• Published in: Transplant infectious disease Vol. 3; no. 1; pp. 8 - 15
• Main Authors: Lo, A., Stratta, R.J., Egidi, M.F., Shokouh-Amiri, M.H., Grewal, H.P., Kisilisik, A.T., Trofe, J., Alloway, R.R., Gaber, L.W., Gaber, A.O.
• Format: Journal Article
• Language: English
• Published: Copenhagen Munksgaard International Publishers 01.03.2001; Blackwell
• Subjects: Adult; Anti-Inflammatory Agents - therapeutic use; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Antibiotic Prophylaxis - methods; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiviral agents; Antiviral Agents - therapeutic use; Biological and medical sciences; cytomegalovirus; Cytomegalovirus Infections - drug therapy; Cytomegalovirus Infections - etiology; Female; Follow-Up Studies; ganciclovir; Ganciclovir - therapeutic use; Graft Rejection; Graft Survival - drug effects; Humans; Immunosuppressive Agents - therapeutic use; Kidney Transplantation; Male; Medical sciences; mycophenolate mofetil; Mycophenolic Acid - analogs & derivatives; Mycophenolic Acid - therapeutic use; Pancreas Transplantation; Pharmacology. Drug treatments; Prednisone - therapeutic use; Severity of Illness Index; simultaneous kidney-pancreas transplantation; Survival Analysis; tacrolimus; Tacrolimus - therapeutic use; Mofetil; Chemoprophylaxis; Acyclic nucleoside; Purine nucleoside; Mycophenolic acid; Transplantation; Homotransplantation; Betaherpesvirinae; Kidney; Human cytomegalovirus; Ganciclovir; Surgery; Antiviral; Complication; Pancreas; Human; Postoperative; Corticosteroid; Drug combination; Herpesviridae; Treatment efficiency; Prednisone; Infection; Virus; Chemotherapy; Treatment; Tacrolimus; Viral disease; Immunosuppressive agent
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1034/j.1399-3062.2001.003001008.x

: Background: The impact of tacrolimus (TAC), mycophenolate mofetil (MMF) and steroid immunosuppression on cytomegalovirus (CMV) infection in combination with ganciclovir prophylaxis in simultaneous kidney–pancreas transplantation (SKPT) has not been well studied. Methods: A retrospective analysis was made of 75 SKPTs performed between 1 January 1996 and 7 January 1999. All patients received ganciclovir for 3 months, but CMV donor (D)+/ recipient (R)− patients received ganciclovir for 6 months. Results: 16/74 (22%) were CMV D+/R−, 25 (33%) D+/R+, 16 (22%) D−/R+, and 17 (23%) D−/R− (1 patient with unknown donor serology was excluded). The mean time to CMV infection was 198 days post‐transplant. The incidence of either CMV infection or tissue invasive CMV disease was 16/74 (22%), including 9 (12%) with CMV infection and 7 (10%) CMV disease. The one‐year patient, kidney, and pancreas graft survival rates were 91%, 89%, and 83%, respectively. The mean follow‐up was 29 months (minimum of 12 months). CMV infection was not associated with an increased incidence of graft failure or mortality. The D+/R− group had the highest incidence of CMV infection (44%) compared with the other serologic groups (17%, P=0.02). Concurrent CMV and rejection occurred more frequently in the D+/R− than the other serologic groups (25% vs. 7%, P=0.03). The D−/R− group had the best outcomes, with no CMV infection, improved kidney graft survival at the end of follow‐up (82% vs. 72%, P=0.04) and the highest event‐free survival (no CMV infection, rejection, or graft loss) when compared to the other groups (76% vs. 33%, P<0.01). Conclusions: Compared to previous studies, ganciclovir prophylaxis delayed the onset and reduced the severity of CMV infection in patients receiving TAC, MMF, and steroids. Despite ganciclovir prophylaxis, CMV seronegative patients receiving CMV D+ organs had worse outcomes than seronegative recipients receiving CMV D− organs.