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A new strategy of delayed long-term prophylaxis could prevent cytomegalovirus disease in (D+/R-) solid organ transplant recipients.

Authors :
San Juan R
Yebra M
Lumbreras C
López-Medrano F
Lizasoain M
Meneu JC
Delgado J
Andrés A
Aguado JM
Source :
Clinical transplantation [Clin Transplant] 2009 Sep-Oct; Vol. 23 (5), pp. 666-71. Date of Electronic Publication: 2009 Aug 17.
Publication Year :
2009

Abstract

Long-term prophylaxis against cytomegalovirus (CMV) started immediately after transplantation in (D+/R-) poses a higher risk of late-onset CMV disease. Delayed CMV prophylaxis could allow a transitory exposure of the immune system to CMV, which would let the immune system mount an adequate CMV-specific cytotoxic response in (D+/R-) patients and confer protection against CMV disease. We included all (D+/R-) solid organ transplant recipients (SOT) performed at our institution (January 3/October 6) who received CMV prophylaxis (mainly with oral valganciclovir) during 100 d. In the first period (until December 4), prophylaxis was initiated immediately after transplantation (conventional prophylaxis: CP). Since January 5, it was initiated after 14 d (delayed prophylaxis: DP). Incidence and severity of CMV disease was compared between both groups. A total of 44 SOT recipients were included (CP: 26 and DP: 18). CMV disease was diagnosed in eight patients (18%), seven of 26 (27%) in the CP group, and one of 18 (5.5%) in the DP group (p = 0.07). CMV colitis was reported in five of 26 patients in the CP group (19%), whereas there were no cases of visceral CMV disease in the DP group (p = 0.048). A 14-d delay in the beginning of long-term prophylaxis against CMV in (D+/R-) is safe and could prevent the onset of late-CMV disease.

Details

Language :
English
ISSN :
1399-0012
Volume :
23
Issue :
5
Database :
MEDLINE
Journal :
Clinical transplantation
Publication Type :
Academic Journal
Accession number :
19689451
Full Text :
https://doi.org/10.1111/j.1399-0012.2009.01077.x