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Study reveals optimal treatment for most common infection after organ transplantation

2012-08-24 11:41  American Society of Nephrology
内容快照:

Highlights

  • Waiting to treat cytomegalovirus infections in transplant recipients until they reach a certain threshold is better than prophylactically treating all recipients.
  • Patients who were pre-emptively treated experienced less kidney scaring and better long-term organ survival than patients prophylactically treated.
  • Cytomegalovirus infection is the most common infection in organ transplant recipients.

Washington, DC (August 23, 2012) ? Waiting to treat the commonest viral infections in transplant recipients until they reach a certain threshold is better than prophylactically treating all recipients, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN).

Cytomegalovirus (CMV) infection is the most common infection in organ transplant recipients, who are susceptible to infections in general because they must take immunosuppressive medications long term. CMV infections can cause increased risks of other infections, organ rejection, heart complications, and diabetes.

The two main strategies against CMV are called universal antiviral prophylaxis and pre-emptive therapy. In universal prophylaxis all patients at risk are given antiviral drugs (such as valganciclovir, valacyclovir, and ganciclovir) for several months after transplantation. In pre-emptive therapy, patients are intensively monitored for CMV activity by sensitive laboratory methods, and short-term antiviral treatment is given only to those with significant viral counts before symptoms occur.

To compare these strategies, Tomas Reischig, MD, PhD (Charles University Medical School and Teaching Hospital, in Pilsen, Czech Republic) and his colleagues assigned kidney transplant recipients梬ho either had CMV present in their blood or who received transplants from donors with CMV in their blood梩o either three months of prophylaxis with valacyclovir or pre-emptive valganciclovir given when significant CMV counts were detected.

Among the major findings for 55 patients after three years:

  • CMV disease developed in 6% of patients in the pre-emptive therapy group and in 9% receivin prophylaxis
  • Patients in the prophylaxis group were 2.5 times more likely to develop moderate-to-severe kidney scaring and atrophy than patients receiving pre-emptive therapy.
  • Kidney biopsies showed that the prophylaxis group also had significantly higher expression of genes involved in kidney scaring.
  • The occurrence of CMV was similar in both groups, but pre-emptive therapy improved 4-year survival of transplanted organs (92% vs 74%).

These findings indicate that compared with valacyclovir prophylaxis, pre-emptive valganciclovir therapy for CMV may lead to less severe kidney scaring and atrophy and to significantly better survival of transplanted organs.

"In the view of short-term trial results, which favor CMV prophylaxis over pre-emptive strategy because of lower risk of acute rejection, we expected a translation of presumed benefit of prophylaxis to the long-term post-transplant period. In fact, we discovered that the opposite is true," said Dr. Reischig.

###

Study co-authors include Petra Hribova, MSc, Pavel Jindra, MD, PhD, Ondrej Hes, Prof, MD, PhD, Mirko Bouda, MD, Vladislav Treska, Prof, MD, PhD, Ondrej Viklicky, Prof, MD, PhD.

Disclosures: The authors reported no financial disclosures.

The article, entitled "Long-term Outcomes of Pre-emptive Valganciclovir Compared with Valacyclovir Prophylaxis for Prevention of Cytomegalovirus in Renal Transplantationwill appear online at http://jasn.asnjournals.org/ on August 23, 2012, doi: 10.1681/ASN.2012010100.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, and with more than 13,500 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.

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