Comparison of prophylactic versus preemptive treatments in the management of cytomegalovirus infection in renal transplant recipients

Keywords: cytomegalovirus infection, renal transplantation, preemptive treatment, prophylactic treatment, valganciclovir


To prevent acute or chronic rejection in renal transplant recipients, immunosuppressive treatments are applied. However, immunosuppressive treatments increase the risk of cytomegalovirus (CMV) infection. The aim of this study was to evaluate the differences in efficacy and cost of prophylactic and preemptive treatment strategies applied in respect of CMV infection to renal transplant recipients.

Methods. Patients who underwent renal transplantation in our center between 2010 and 2015, were retrospectively analyzed. The patients were allocated in two groups as those who received prophylaxis or preemptive treatment. A record was made of the kidney function tests (KFT), CMV PCR copy numbers, the presence of CMV infection, antiviral treatments received, and the costs were calculated of the tests and treatments. The groups were compared in respect of CMV infection and costs.

Results. A total of 71 patients with a median age of 38 years (range, 19-74 years) were included in the study. The prophylaxis group included 43 patients and the preemptive group included 28 patients. CMV infection was detected in 7 (16.3%) of the prophylaxis group and 2 (7.1%) patients of the preemptive group (p=0.467). The cost per month of the tests and treatment was lower in the preemptive group than in the prophylaxis group (p<0.001).

Conclusion. No significant difference was determined between the prophylactic and preemptive treatment protocols in respect of the CMV infection in the intermediate-risk group renal transplantation recipients. Preemptive treatment was seen to be a more cost-effective method than prophylactic treatment in Turkey.


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Fishman JA, Emery V, Freeman R, Pascual M, Rostaing L, Schlitt HJ, et al. Cytomegalovirus in transplantation - challenging the status quo. Clin Transplant. 2007;21(2):149-58. doi: 10.1111/j.1399-0012.2006.00618.x.

Sagedal S, Hartmann A, Nordal KP, Osnes K, Leivestad T, Foss A, et al. Impact of early cytomegalovirus infection and disease on long-term recipient and kidney graft survival. Kidney Int. 2004;66(1):329-37. doi: 10.1111/j.1523-1755.2004.00735.x.

Arthurs SK, Eid AJ, Pedersen RA, Dierkhising RA, Kremers WK, Patel R, et al. Delayed-onset primary cytomegalovirus disease after liver transplantation. Liver Transpl. 2007;13(12):1703-9. doi: 10.1002/lt.21280.

Helantera I, Egli A, Koskinen P, Lautenschlager I, Hirsch HH. Viral impact on long-term kidney graft function. Infectious disease clinics of North America. 2010;24(2):349-50. doi: 10.1016/j.idc.2010.02.003.

Humar A, Snydman D. Cytomegalovirus in solid organ transplant recipients. American journal of transplantation: official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2009;9 Suppl 4:S78-86. doi: 10.1111/j.1600-6143.2009.02897.x.

Paya CV. Prevention of cytomegalovirus disease in recipients of solid-organ transplants. Clin Infect Dis. 2001;32(4):596-603. doi: 10.1086/318724.

Ono G, Medina Pestana JO, Aranha Camargo LF. Late cytomegalovirus (CMV) infections after kidney transplantation under the preemptive strategy: Risk factors and clinical aspects. Transplant infectious disease: an official journal of the Transplantation Society. 2019;21(2):e13035. doi: 10.1111/tid.13035.

Kotton CN, Kumar D, Caliendo AM, Huprikar S, Chou S, Danziger-Isakov L, et al. The Third International Consensus Guidelines on the Management of Cytomegalovirus in Solid Organ Transplantation. Transplantation. 2018. doi: 10.1097/tp.0000000000002191.

Florescu DF, Qiu F, Schmidt CM, Kalil AC. A direct and indirect comparison meta-analysis on the efficacy of cytomegalovirus preventive strategies in solid organ transplant. Clin Infect Dis. 2014;58(6):785-803. doi: 10.1093/cid/cit945.

Reischig T, Jindra P, Hes O, Svecova M, Klaboch J, Treska V. Valacyclovir prophylaxis versus preemptive valganciclovir therapy to prevent cytomegalovirus disease after renal transplantation. American journal of transplantation: official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 2008;8(1):69-77. doi: 10.1111/j.1600-6143.2007.02031.x.

Kotton CN. Management of cytomegalovirus infection in solid organ transplantation. Nat Rev Nephrol. 2010;6(12):711-21. doi: 10.1038/nrneph.2010.141.

Owers DS, Webster AC, Strippoli GF, Kable K, Hodson EM. Pre-emptive treatment for cytomegalovirus viraemia to prevent cytomegalovirus disease in solid organ transplant recipients. Cochrane Database Syst Rev. 2013;(2):Cd005133. doi: 10.1002/14651858.CD005133.pub3.

European Best Practice Guidelines for Renal Transplantation (part 1). Nephrol Dial Transplant. 2000;15 Suppl 7:1-85.

Kielberger L, Bouda M, Jindra P, Reischig T. Pharmacoeconomic impact of different regimens to prevent cytomegalovirus infection in renal transplant recipients. Kidney & blood pressure research. 2012;35(6):407-16. doi: 10.1159/000335962.

Witzke O, Nitschke M, Bartels M, Wolters H, Wolf G, Reinke P, et al. Valganciclovir Prophylaxis Versus Preemptive Therapy in Cytomegalovirus-Positive Renal Allograft Recipients: Long-term Results After 7 Years of a Randomized Clinical Trial. Transplantation. 2018;102(5):876-82. doi: 10.1097/tp.0000000000002024.

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How to Cite
Karaçin, C., Yaşar, E., Helvacı, Özant, & Güz, G. (2020). Comparison of prophylactic versus preemptive treatments in the management of cytomegalovirus infection in renal transplant recipients. Ukrainian Journal of Nephrology and Dialysis, (3(67), 67-72.