CMV ANTIGENEMIA IS NOT ASSOCIATED WITH ADVERSE GRAFT OUTCOME OR CMV DISEASE IN INTERMEDIATE RISK TRANSPLANT RECIPIENTS.

Abstract

P806 Aims: Pretransplant CMV seropositive kidney transplant recipients (KTR) carry a low risk for CMV disease unless they receive antilymphocyte therapy (ALT), however, administration of antiviral prophylaxis is a common management strategy with the theoretical objective of avoiding the indirect effects of CMV. In order to evaluate incidence of CMV infection/disease in a group of KTR [Donor CMV +or-/Recipient CMV+, (D+or-/R+)] and its impact in graft function in the absence of CMV prophylaxis, we performed this prospective study (Nov/01-Sep/03). Methods: Pretransplant CMV antibodies were determined by ELISA. CMV antigenemia (Ag) was assessed by monoclonal antibody against pp65: assay performed biweekly for the first 3 months posttransplant and then monthly up to 6 months. If positive (one antigen positive cell/150x103), the Ag assay was performed weekly. Ganciclovir IV was given only upon development of CMV disease. All KTR received triple or quadruple immunosuppressive Tx without ALT induction. Acute rejection (AR) clinically suspected was biopsy confirmed. Variables recorded: Transplant date, KTR age, gender, donor source, pretransplant CMV status, time to Ag+, and number of positive cells/assay. Follow-up visits: Clinical evaluation of CMV related symptoms, blood cell count, serum creatinine (SCr), liver function tests, and urinalysis. Results: We evaluated 75 KTR CMV+, mean age 33±3 y, 65% male; 84% received the kidney from living donors. Mean follow-up 522±227days. The incidence of CMV Ag+ was 36.8%. The time elapsed between the transplant and the first positive antigenemia was 60.3±36.3 days; the number of positive cells/assay fluctuated from 1 to 1900; and the mean duration of antigenemia before its spontaneous disappearance was 101±55 days. Only two Ag+ patients developed CMV disease (2.6 %). The incidence of AR episodes was 7.1 and 6.4 % for Ag+ and Ag- patients, respectively, p=0.7. Mean SCr for Ag+ patients was 1.63 ± 0.13 and 1.49 ± 0.11 mg/dl before the first positive antigenemia result (1 month posttransplant) and at 6 months, respectively. For those who remained Ag- during follow-up, the mean SCr was 1.31± 0.1 and 1.24 ± 0.04 at one month posttransplant and at 6 months, respectively. There were not differences between Ag+ vs Ag- patients regarding mean SCr at baseline and at 6 months. Conclusions: CMV transient antigenemia is a frequent finding in KTR with intermediate risk. In this group of patients the incidence of CMV disease is low and there is no impact on graft function. We believe that universal use of CMV prophylaxis in these patients is not necessary and treatment must be individualized.