Author/Authors :
Cunha, L Renal Department - Hospital Prof. Dr. Fernando Fonseca - Amadora, Portugal , Laranjinha, I Renal Transplantation Department - Hospital de Santa Cruz - Lisboa, Portugal , Birne, R Renal Transplantation Department - Hospital de Santa Cruz - Lisboa, Portugal , Jorge, C Renal Transplantation Department - Hospital de Santa Cruz - Lisboa, Portugal , Carvalho, T. J Renal Transplantation Department - Hospital de Santa Cruz - Lisboa, Portugal , Lança, A Renal Department - Hospital Rainha Santa Isabel - Torres Novas, Portugal , Coelho, S Renal Department - Hospital São Bernando - Setúbal, Portugal , Bruges, M Renal Transplantation Department - Hospital de Santa Cruz - Lisboa, Portugal , Machado, D Renal Transplantation Department - Hospital de Santa Cruz - Lisboa, Portugal
Abstract :
Background: Despite a reduction in the incidence of cytomegalovirus (CMV) infections after kidney
transplantation, less is known about late CMV infection in kidney transplant recipients.
Objective: To assess incidence of CMV infection in a cohort of patients under a high surveillance CMV
prevention protocol and identify factors associated with late CMV infection.
Methods: Analysis of a consecutive cohort of 181 kidney allograft recipients between January 2012
and Aug 2015. CMV prevention-protocol consisted of 6-month universal prophylaxis and pre-emptive
therapy for high-risk group (D+/R– or patients submitted to lymphocyte-depleting agent for induction or
rejection treatment) and pre-emptive therapy for standard-risk group (D±/R+). Stopping valganciclovir
was followed by CMV screening in the next two appointments.
Results: CMV infection was identified in 73 of 181 patients; the rate in high-risk group and standard-risk
group was similar (p=0.443). However, in the latter group, the infection occurred mostly in the first 6
months. Late CMV infection occurred in 25 of 181 patients (5 of standard-risk group and 20 of high-risk
group), after a median (IQR) of 253 (230.3–312.3) days after transplantation and 55 (41–89.5) days after
the protocol period. Screening for CMV after valganciclovir discontinuation revealed 56% of late CMV
infections. In high-risk group, D+/R– was associated with late CMV infection (HR 2.7, p=0.039) and in
standard-risk group; lower age was associated with late CMV infection (HR 0.89, p=0.02).
Conclusion: The incidence of CMV infection was similar to that reported in the literature. In high-risk
patients, antigenemia surveillance during prophylaxis did not appear to reduce late CMV infections.
Antigenemia screening after valganciclovir had limited results in the diagnosis of late CMV infection.
D+/R– was associated to late CMV infection in high-risk group. Lower age appeared to influence late CMV
infection in standard-risk group.
