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. 2023 Aug 1;107(8):1846-1853.
doi: 10.1097/TP.0000000000004615. Epub 2023 Jul 20.

Cytomegalovirus High-risk Kidney Transplant Recipients Show No Difference in Long-term Outcomes Following Preemptive Versus Prophylactic Management

Kjersti B Blom  1   2   3 , Grete K Birkeland  4 , Karsten Midtvedt  5 , Trond G Jenssen  5   6 , Anna V Reisæter  5 , Halvor Rollag  6 , Anders Hartmann  5 , Solbjørg Sagedal  1 , Ivar Sjaastad  2 , Garth Tylden  7 , Gro Njølstad  8 , Einar Nilsen  9 , Andreas Christensen  10 , Anders Åsberg  5   11   12 , Jon A Birkeland  1
Affiliations

Cytomegalovirus High-risk Kidney Transplant Recipients Show No Difference in Long-term Outcomes Following Preemptive Versus Prophylactic Management

Kjersti B Blom et al. Transplantation. .

Abstract

Background: Following kidney transplantation (KT), cytomegalovirus (CMV) infection remains an important challenge. Both prophylactic and preemptive antiviral protocols are used for CMV high-risk kidney recipients (donor seropositive/recipient seronegative; D+/R-). We performed a nationwide comparison of the 2 strategies in de novo D+/R- KT recipients accessing long-term outcomes.

Methods: A nationwide retrospective study was conducted from 2007 to 2018, with follow-up until February 1, 2022. All adult D+/R- and R+ KT recipients were included. During the first 4 y, D+/R- recipients were managed preemptively, changing to 6 mo of valganciclovir prophylaxis from 2011. To adjust for the 2 time eras, de novo intermediate-risk (R+) recipients, who received preemptive CMV therapy throughout the study period, served as longitudinal controls for possible confounders.

Results: A total of 2198 KT recipients (D+/R-, n = 428; R+, n = 1770) were included with a median follow-up of 9.4 (range, 3.1-15.1) y. As expected, a greater proportion experienced a CMV infection in the preemptive era compared with the prophylactic era and with a shorter time from KT to CMV infection ( P < 0.001). However, there were no differences in long-term outcomes such as patient death (47/146 [32%] versus 57/282 [20%]; P = 0.3), graft loss (64/146 [44%] versus 71/282 [25%]; P = 0.5), or death censored graft loss (26/146 [18%] versus 26/282 [9%]; P = 0.9) in the preemptive versus prophylactic era. Long-term outcomes in R+ recipients showed no signs of sequential era-related bias.

Conclusions: There were no significant differences in relevant long-term outcomes between preemptive and prophylactic CMV-preventive strategies in D+/R- kidney transplant recipients.

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Conflict of interest statement

The authors declare no funding or conflicts of interest.

Figures

None
Graphical abstract
FIGURE 1.
FIGURE 1.
Flowchart of the study population from 2007 to 2018. CMV, cytomegalovirus; D+/R–, CMV-seropositive donor to CMV-seronegative recipient; D–/R–, CMV-seronegative donor to CMV-seronegative recipient; D?/R?, unknown CMV serology in donor and/or recipient; R+, CMV-seropositive recipient; Tx, transplantation.
FIGURE 2.
FIGURE 2.
Long-term outcomes in D+/R– kidney graft recipients in the 2 eras. A, Occurrence of CMV infection in D+/R– kidney graft recipients by CMV treatment (preemptive or prophylaxis), Norway 2007 to 2021. B, Occurrence of CMV infection ≥5000 IU/mL in D+/R– kidney graft recipients by CMV treatment (preemptive or prophylaxis), Norway 2007 to 2021. C, Patient survival in D+/R– kidney graft recipients by CMV treatment (preemptive or prophylaxis), Norway 2007 to 2021. D, Uncensored graft survival in D+/R– kidney graft recipients by CMV treatment (preemptive or prophylaxis), Norway 2007 to 2021. CMV, cytomegalovirus; D+/R–, CMV-seropositive donor to CMV-seronegative recipient; Tx, transplantation.
FIGURE 3.
FIGURE 3.
Long-term outcomes in R+ kidney graft recipients in the 2 eras. A, Occurrence of CMV infection in R+ kidney graft recipients, by time period, 2007 to 2010 vs 2011 to 2021. B, Patient survival in R+ kidney graft recipients, by time period, 2007 to 2010 vs 2011 to 2021. C, Uncensored graft survival in R+ kidney graft recipients, by time period, 2007 to 2010 vs 2011 to 2021. CMV, cytomegalovirus; R+, CMV-seropositive recipient; Tx, transplantation.
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References

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