MON-198 EVALUATION OF CYTOMEGALO VIRUS (CMV) TREATMENT IN KIDNEY TRANSPLATATION: A MULTI-CENTRAL STUDY IN VIET NAM

Abstract

Cytomegalovirus (CMV) infection is associated with significantly decreased outcomes of kidney transplantation (KTx). To evaluate the effectiveness of CMV prevention and treatment in KTx patients in Viet Nam was the aim of our multicenter study. We conducted a prospective cross-sectional study about prevention and treatment of CMV in 847 patients (pts) from 7 KTx centers in Viet Nam. The immunosuppressive drugs used depend on each center, with Basiliximab for induction, and with Calcineurin inhibitors (tacrolimus or cyclosporine), Antiproliferative agents (mycophenolate mofetil, or mycophenolate sodium or azathioprine), mTOR inhibitor, steroids for maintenance. CMV prevention was taken with either acyclovir (ACY) (dose 200mgx4) or valganciclovir (VALG) (dose 450mg) for the first 100 to 200 days after KTx. CME infection was diagnosed by CMV-DNA, and treated with intravenous ganciclovir (5mg/kg/12h). Ganciclovir, ACY or VALG dose were adjusted to the kidney function. Preemptive therapy was defined as CMV-DNA, when it was switched from negative to positive even if the number of copies was less than 500 (in the time of CMV prophylaxis, but the patient was in the high risk group (D+/R- or after acute rejection treatment progress). 847 KTx patients from 1992 to 2015, were recruited living and deceased donor transplantation. Mean age: 42.5 ± 12.7yo (11yso; 81yso). Male /female: 576/271. 581/847pts (68.60%) received CMV prevention and 266/847 (31.40%) pts didn't received CMV prevention. Of 581 CMV prevention, 28 proceed CMV infection. All of them were on ACY prevention (except 10pts of D-/R- group). 3/28pts died because of late detective of severe pneumonia (table 1). Table 1CMV risk classificationsCMV risk classificationsTotalPrevention (n=581)Infection (n=189)Pre-emptiveDeathACYValGACYValGGanciclovirACYValGD+/R+796493592802830D+/R-198500000D-/R+1710100000D-/R-154100000Total84751566280283/28 (10.71%)0n=847 (%)581/847 (68.60%)28/581 (4.82%)3/581 (0.52%) Open table in a new tab Of 266pts without CMV prevention, 42pts suffered CMV infection, and all received preemptive therapy. 11/42pts died because of severe pneumonia, too. Table 2CMV risk classifications of CMV non- prevention group treatmentCMV risk classificationsTotalCMV non- preventionCMV infectionPre-emptiveDeathD+/R+796244404011D+/R-196000D-/R+176110D-/R-1510110Total84726642/266 (15.76%)4211/42 (26.19%)n=847 (%)84731.404.96 Open table in a new tab In the non- CMV prevention group, the percentage of infection was triple (42/266, 15.76%) than the acyclovir prevention group (3/581 (0.52%)) with p<0.005, (table 1 and 2). Frequency of CMV in the dialysis community is CMV infection of 95.99%. Valganciclovir was highly efficient for CMV prevention than acyclovir. In our study, aciclovir is still effectively, so we must be to follow-up patients carefully and early convert Aciclovir to ValG or Ganciclovir when the CMV-DNA was switched from negative to positive. CMV prophylaxis should recommended for all of patients even the D-/R- group if they were receiving the high level of immunosuppressive drug. In addition, the level of immunosuppressive drugs should be adjusted to suit each individual.