A new strategy of delayed long-term prophylaxis could prevent cytomegalovirus disease in (D+/R−) solid organ transplant recipients

• Published in: Clinical transplantation Vol. 23; no. 5; pp. 666 - 671
• Main Authors: Juan, R. San, Yebra, M., Lumbreras, C., López-Medrano, F., Lizasoain, M., Meneu, J.C., Delgado, J., Andrés, A., Aguado, J.M.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.09.2009; Wiley
• Subjects: Adult; Antiviral Agents - therapeutic use; Biological and medical sciences; Cytomegalovirus - pathogenicity; cytomegalovirus disease; Cytomegalovirus Infections - prevention & control; Cytomegalovirus Infections - virology; D+/R; delayed; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Ganciclovir - analogs & derivatives; Ganciclovir - therapeutic use; Graft Rejection - immunology; Humans; Medical sciences; Organ Transplantation; Prevention and actions; Prognosis; prophylaxis; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Rate; Tissue, organ and graft immunology; transplantation; Transplantation Immunology; Treatment Outcome; Herpesviridae; Solid organ; Transplantation; delayed; Homotransplantation; Betaherpesvirinae; Long term; cytomegalovirus disease; prophylaxis; Delay; Human cytomegalovirus; Infection; Virus; Medicine; Prevention; Treatment; D+/R; Surgery; Viral disease; Graft; Strategy
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/j.1399-0012.2009.01077.x

:  Long‐term prophylaxis against cytomegalovirus (CMV) started immediately after transplantation in (D+/R−) poses a higher risk of late‐onset CMV disease. Delayed CMV prophylaxis could allow a transitory exposure of the immune system to CMV, which would let the immune system mount an adequate CMV‐specific cytotoxic response in (D+/R−) patients and confer protection against CMV disease. We included all (D+/R−) solid organ transplant recipients (SOT) performed at our institution (January 3/October 6) who received CMV prophylaxis (mainly with oral valganciclovir) during 100 d. In the first period (until December 4), prophylaxis was initiated immediately after transplantation (conventional prophylaxis: CP). Since January 5, it was initiated after 14 d (delayed prophylaxis: DP). Incidence and severity of CMV disease was compared between both groups. A total of 44 SOT recipients were included (CP: 26 and DP: 18). CMV disease was diagnosed in eight patients (18%), seven of 26 (27%) in the CP group, and one of 18 (5.5%) in the DP group (p = 0.07). CMV colitis was reported in five of 26 patients in the CP group (19%), whereas there were no cases of visceral CMV disease in the DP group (p = 0.048). A 14‐d delay in the beginning of long‐term prophylaxis against CMV in (D+/R−) is safe and could prevent the onset of late‐CMV disease.