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Six-month low-dose valganciclovir prophylaxis in cytomegalovirus D+/R- kidney transplant patients receiving thymoglobulin induction.

AbstractBACKGROUND:
The use of T-cell-depleting antibody, such as thymoglobulin, is a risk factor for cytomegalovirus (CMV) infection. We studied the effectiveness of 6 months of low-dose valganciclovir prophylaxis in CMV-naive kidney transplant recipients of CMV-positive donor kidney (D+/R-) receiving thymoglobulin induction.
METHODS:
We included all D+/R- kidney transplant patients between October 2005 and December 2010 who received valganciclovir 450 mg daily for 6 months as per center protocol. CMV infection was confirmed by positive viremia. Kaplan-Meier and multivariate Cox proportional regression analyses were employed to compare the risk of CMV infection between patients with and without the use of thymoglobulin induction.
RESULTS:
Out of 170 D+/R- kidney transplant patients, 42 cases of CMV infection (24.6%) were diagnosed after a median follow-up of 3.2 years: six patients from the noninduction (9.4%) and 36 from the induction cohort (34.0%). The induction with thymoglobulin was associated with four times greater risk of developing CMV infection (adjusted hazard ratio: AHR 4.15, 95% 1.75, 9.86, P = .001). The use of thymoglobulin was associated with leukopenia but not neutropenia.
CONCLUSIONS:
Additional measures are needed to reduce the elevated incidence of CMV infection in D+/R- kidney transplant patients receiving induction with thymoglobulin.
AuthorsF L Luan
JournalTransplantation proceedings (Transplant Proc) 2013 Jan-Feb Vol. 45 Issue 1 Pg. 175-7 ISSN: 1873-2623 [Electronic] United States
PMID23267799 (Publication Type: Journal Article)
CopyrightCopyright © 2013 Elsevier Inc. All rights reserved.
Chemical References
  • Antilymphocyte Serum
  • Antiviral Agents
  • Immunosuppressive Agents
  • thymoglobulin
  • Valganciclovir
  • Ganciclovir
Topics
  • Adult
  • Antilymphocyte Serum (immunology)
  • Antiviral Agents (therapeutic use)
  • Cohort Studies
  • Cytomegalovirus
  • Cytomegalovirus Infections (complications, drug therapy, prevention & control)
  • Female
  • Ganciclovir (analogs & derivatives, therapeutic use)
  • Humans
  • Immunosuppressive Agents
  • Kidney Failure, Chronic (surgery)
  • Kidney Transplantation (methods)
  • Leukopenia (etiology)
  • Male
  • Middle Aged
  • Neutropenia (etiology)
  • Proportional Hazards Models
  • Regression Analysis
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Tissue Donors
  • Treatment Outcome
  • Valganciclovir

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