Prevention of cytomegalovirus infection after kidney transplantation

Abstract

Uvod: Prema važećem preporukama opća profilaksa citomegalovirusne (CMV) infekcije uputna je kod pacijenata kojima je transplantiran bubreg. Cilj naše studije bio je analizirati učestalost CMV viremije/bolesti kod pacijenata koji su primili CMV profilaksu u odnosu na pacijente koji nisu primili CMV profilaksu. Ispitanici i metode: Retrospektivnom analizom analizirali smo 521 pacijenta prosječne životne dobi 48,9 ± 13,6 godina u razdoblju od 1. 1. 1990. do 31. 12. 2014. Od 521 analiziranog pacijenta, 426 pacijenata nije primilo CMV profilaksu, a 95 pacijenata primilo je CMV profilaksu peroralnim valganciklovirom tijekom tri do šest mjeseci nakon transplantacije. Rezultati: Pacijenti koji su primili CMV profilaksu imali su značajno nižu učestalost CMV bolesti u usporedbi s pacijentima koji nisu primali profilaksu (2,1 % vs. 8,7 %; P = 0,046). Pacijenti koji su primali CMV profilaksu imali su nižu učestalost CMV viremije u odnosu na pacijente koji nisu primali CMV profilaksu, ali ova razlika nije bila statistički značajna (3,2 % vs. 9,4 %; P = 0,073). Pacijenti koji su primili CMV profilaksu imali su niže vrijednosti kreatinina nakon prve postoperativne godine, ali niti ova razlika nije bila statistički značajna (131,1 ± 66,4 vs. 145,6 ± 88,5; P = 0,173). Veći udio pacijenata koji nisu primili CMV profilaksu izgubio je bubrežni transplantat nakon prve godine poslije transplantacije u odnosu na udio pacijenata koji je primio CMV profilaksu, ali ta razlika također nije bila statistički značajna. U skupini pacijenata koja je primila profilaksu najčešći razlozi za gubitak transplantata bili su krize odbacivanja i kirurške komplikacije, a u skupini pacijenata koja nije primila profilaksu najčešći uzroci bili su kronična nefropatija transplantata i kirurške komplikacije. Zaključak: Profilaktička primjena valganciklovira učinkovita je u prevenciji CMV infekcije nakon transplantacije bubrega.Introduction: According to the current guidelines prophylactic treatment for Cytomegalovirus (CMV) is recommended in solid organ transplantation. We were interested to explore the prevalence of CMV viremia/disease due to use of prophylactic treatment in our renal transplant recipients (RTRs). Patients and methods: We retrospectively examined the 24-year (from 01.01.1990 to 31.12.2014) data of 521 RTRs mean age 48.9 ± 13.6 years. 95 RTRs were received prophylaxis for CMV and 426 patients didn’t receive prophylactic treatment. Results: Prophylactic treatment significantly reduced the incidence of CMV disease during the first-year after transplantation (2.1 % vs. 8.7 %; P = 0.046). Although the prevalence of CMV viremia was higher in the group of patients that didn’t receive prophylaxis, that difference was not statistically significant (3.2 % vs. 9.4 %; P = 0.073). The mean values of serum creatinine didn’t show any significant differences after one-year of follow-up between the RTRs who received prophylaxis in comparison to the patients that didn’t receive prophylactic treatment (131.1 ± 66.4 vs. 145.6 ± 88.5; P = 0.173). Although the loss of renal allograft was higher in the group of patients that didn’t receive prophylactic treatment, that difference was not statisticaly significant. In the group of patients who received prophylaxis the main reasons for graft loss were an acute rejection and surgical complications, while surgical complications and chronic allograft nephropathy were the most common reasons for graft loss in the second group of RTRs. Conclusion: Prophylactic treatment with vanganciklovir for CMV is an effective way to prevent CMV disease after renal transplantation