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. 2009 Oct;11(5):400-4.
doi: 10.1111/j.1399-3062.2009.00416.x. Epub 2009 Jun 29.

Preemptive therapy is not adequate for prevention of cytomegalovirus disease in pancreas-kidney transplant recipients

F López-Medrano  1 , B Rueda, M Lizasoain, R San Juan, D Folgueira, A Andrés, J M Morales, C Jiménez, J C Meneu, J M Aguado
Affiliations

Preemptive therapy is not adequate for prevention of cytomegalovirus disease in pancreas-kidney transplant recipients

F López-Medrano et al. Transpl Infect Dis. 2009 Oct.

Abstract

Background: Cytomegalovirus (CMV) remains the most common viral infection after pancreas-kidney transplantation (PKT). Comparative studies about CMV prophylaxis in PKT have not been developed.

Methods: We analyzed CMV disease in a cohort of 84 PKT recipients. All received intravenous ganciclovir during treatment with anti-thymocyte globulin and later one of the following options for pre-transplant CMV-seropositive recipients: (a) no prophylaxis (n=10 patients), (b) preemptive therapy (PT) (n=13), or (c) continuous prophylaxis (CP) for 12 weeks (n=29). Pre-transplant CMV-seronegative recipients received CP (n=21).

Results: Eleven patients were excluded because of organ explantation in the first 15 days. Incidence of CMV disease in seropositive recipients was 30% under no prophylaxis, 23% under PT, and 6.9% under CP. Incidence of CMV disease under CP was 33.3% in seronegative recipients. Six of 9 episodes of CMV disease under CP occurred after finishing prophylaxis. Under CP, the incidence of CMV disease was significantly higher in seronegative than in seropositive recipients (P<0.05).

Conclusion: According to the results of our study, for CMV-seropositive PKT recipients, CP is a better strategy than PT. For CMV-seronegative recipients, 3 months of CP is an inadequate strategy.

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