Targeted preemptive therapy according to perceived risk of CMV infection after kidney transplantation

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dc.citation.issue6
dc.citation.volume20
dc.contributor.authorPinto, Cahue Henrique [UNIFESP]
dc.contributor.authorTedesco-Silva Junior, Hélio [UNIFESP]
dc.contributor.authorFelipe, Claudia Rosso [UNIFESP]
dc.contributor.authorFerreira, Alexandra Nicolau [UNIFESP]
dc.contributor.authorCristelli, Marina [UNIFESP]
dc.contributor.authorViana, Laila Almeida [UNIFESP]
dc.contributor.authorAguiar, Wilson [UNIFESP]
dc.contributor.authorPestana, Jose Osmar Medina [UNIFESP]
dc.coverageRio De Janeiro
dc.date.accessioned2020-07-31T12:47:22Z
dc.date.available2020-07-31T12:47:22Z
dc.date.issued2016
dc.description.abstractBackground: The identification of the best strategy to manage cytomegalovirus infection is hampered by uncertainties regarding the risk/benefit ratios of universal prophylaxis versus preemptive therapy, the impact of indirect cytomegalovirus effects and the associated costs. This study investigated the efficacy and safety of targeted preemptive therapy according to perceived risk of cytomegalovirus infection after kidney transplantation. Methods: 144 adult kidney transplant recipients were enrolled in this 12-month study. None received cytomegalovirus pharmacological prophylaxis. Only high risk patients (positive donor/negative recipient (D+/R-), use of induction therapy with antithymocyte globulin, treatment of rejection) received preemptive therapy based on the result of pp65 antigenemia test. Low-risk patients with symptoms related to cytomegalovirus were screened for pp65 antigenemia and treatment initiated if confirmed cytomegalovirus disease. Blinded cytomegalovirus DNAemia was collected weekly during the first three months. Results: The incidence of cytomegalovirus infection was 34% and cytomegalovirus disease was 17%. The incidence was 25% in D+/R-, 69% in those receiving induction with rabbit antithymocite globulin (r-ATG), 46% in those treated for acute rejection, and 28% in low risk patients. By week 3 DNAemia was observed in 30% of patients who were not treated for cytomegalovirus infection/disease, and values >= 2.169 UI/mL showed 61% sensitivity and 85% specificity to detect cytomegalovirus disease (AUC = 0.849 +/- 0.042, p < 0.001). Using multivariate analysis, only anti-thymocyte globulin induction was associated with cytomegalovirus infection/disease whereas only expanded donor criteria and renal function at 30 days were associated with renal function 12 months after transplantation. Conclusion: Targeted preemptive therapy in patients with perceived higher risk for cytomegalovirus infection/disease was effective in preventing severe clinical presentation, including tissue invasive and late cytomegalovirus infection. This strategy is associated with direct and indirect cost-savings. (C) 2016 Sociedade Brasileira de Infectologia. Published by Elsevier Editora Ltda. This is an open access article under the CC BY-NC-ND license.en
dc.description.affiliationUniv Fed Sao Paulo Unifesp, Hosp Rim, Disciplina Nefrol, Sao Paulo, SP, Brazil
dc.description.affiliationUniv Fed Sao Paulo Unifesp, Hosp Rim, Serv Urol, Sao Paulo, SP, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo (Unifesp), Hospital do Rim, Disciplina de nefrologia, São Paulo, SP, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo (Unifesp), Hospital do Rim, Serviço de Urologia, São Paulo, SP, Brazil
dc.description.sourceWeb of Science
dc.format.extent576-584
dc.identifierhttp://dx.doi.org/10.1016/j.bjid.2016.08.007
dc.identifier.citationBrazilian Journal Of Infectious Diseases. Rio De Janeiro, v. 20, n. 6, p. 576-584, 2016.
dc.identifier.doi10.1016/j.bjid.2016.08.007
dc.identifier.issn1413-8670
dc.identifier.urihttps://repositorio.unifesp.br/handle/11600/56775
dc.identifier.wosWOS:000389965800008
dc.language.isoeng
dc.publisherElsevier Brazil
dc.relation.ispartofBrazilian Journal Of Infectious Diseases
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectCytomegalovirusen
dc.subjectKidneyen
dc.subjectTransplanten
dc.subjectPreemptive therapyen
dc.titleTargeted preemptive therapy according to perceived risk of CMV infection after kidney transplantationen
dc.typeinfo:eu-repo/semantics/article
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