Universal prophylaxis with valganciclovir versus preemptive therapy in minimizing the risk of cytomegalovirus infection and disease in high-risk and intermediate-risk kidney transplant recipients: a single-center experience

Abstract

Objective Cytomegalovirus (CMV) is one of the most frequent viral pathogens that results in post-transplantation infection. Universal prophylaxis and preemptive therapy have long been used to prevent and treat CMV infection, respectively, in post-transplantation cases. The aim of this study was to compare the universal prophylaxis with valganciclovir versus preemptive therapy in minimizing the risk of CMV infection and disease in high-risk and intermediate-risk kidney transplant recipients. Patients and methods This single-center, retrospective cohort study enrolled 63 kidney transplant recipients between March 2017 and January 2018. The outcome variables were occurrence of CMV infection and CMV disease, 1-year estimated glomerular filtration rate (eGFR), allograft rejection, allograft loss, and mortality within the first year after transplantation in high-risk (D+/R−) patients managed with universal prophylaxis of oral valganciclovir and intermediate-risk (D+/R+ or D−/R+) patients receiving preemptive treatment. Results Of the 63 kidney transplant recipients, 19 (30.2%) were grouped as high risk for CMV infection/disease and 44 (69.8%) were intermediate risk for CMV infection/disease. The average duration of post-transplantation follow-up was 349 (SD 136) days in the high-risk cohort and 335 (SD 112) days in the intermediate-risk cohort (P=0.56). CMV infection was found in 15 (34.1%) of the 44 intermediate-risk patients receiving preemptive therapy and in four (21.1%) of the 19 high-risk patients receiving universal prophylaxis (P Conclusion Intermediate-risk (D+/R+ or D−/R+) kidney transplant recipients receiving preemptive therapy had significantly higher frequency of CMV infection/disease than high-risk (D+/R−) kidney transplant recipients receiving oral valganciclovir universal prophylaxis during early post-transplantation period. No statistically significant differences were found in relation to allograft rejection, allograft loss, eGFR, and mortality at 1 year in both the cohorts.