Pre-emptive therapy better than valacyclovir prophylaxis in treating CMV in transplant recipients

Waiting to treat the commonest viral infections in transplant recipients until they reach a certain threshold is better than prophylactically treating all recipients, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN).

Cytomegalovirus (CMV) infection is the most common infection in organ transplant recipients, who are susceptible to infections in general because they must take immunosuppressive medications long term. CMV infections can cause increased risks of other infections, organ rejection, heart complications, and diabetes.

The two main strategies against CMV are called universal antiviral prophylaxis and pre-emptive therapy. In universal prophylaxis all patients at risk are given antiviral drugs (such as valganciclovir, valacyclovir, and ganciclovir) for several months after transplantation. In pre-emptive therapy, patients are intensively monitored for CMV activity by sensitive laboratory methods, and short-term antiviral treatment is given only to those with significant viral counts before symptoms occur.

To compare these strategies, Tomas Reischig, MD, PhD (Charles University Medical School and Teaching Hospital, in Pilsen, Czech Republic) and his colleagues assigned kidney transplant recipients—who either had CMV present in their blood or who received transplants from donors with CMV in their blood—to either three months of prophylaxis with valacyclovir or pre-emptive valganciclovir given when significant CMV counts were detected.

Among the major findings for 55 patients after three years:

•CMV disease developed in 6% of patients in the pre-emptive therapy group and in 9% receivin prophylaxis
•Patients in the prophylaxis group were 2.5 times more likely to develop moderate-to-severe kidney scaring and atrophy than patients receiving pre-emptive therapy.
•Kidney biopsies showed that the prophylaxis group also had significantly higher expression of genes involved in kidney scaring.
•The occurrence of CMV was similar in both groups, but pre-emptive therapy improved 4-year survival of transplanted organs (92% vs 74%).

These findings indicate that compared with valacyclovir prophylaxis, pre-emptive valganciclovir therapy for CMV may lead to less severe kidney scaring and atrophy and to significantly better survival of transplanted organs.

"In the view of short-term trial results, which favor CMV prophylaxis over pre-emptive strategy because of lower risk of acute rejection, we expected a translation of presumed benefit of prophylaxis to the long-term post-transplant period. In fact, we discovered that the opposite is true," said Dr. Reischig.

Comments

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
Post a new comment
Post

Sign in to keep reading

We're committed to providing free access to quality science. By registering and providing insight into your preferences you're joining a community of over 1m science interested individuals and help us to provide you with insightful content whilst keeping our service free.

or

While we only use edited and approved content for Azthena answers, it may on occasions provide incorrect responses. Please confirm any data provided with the related suppliers or authors. We do not provide medical advice, if you search for medical information you must always consult a medical professional before acting on any information provided.

Your questions, but not your email details will be shared with OpenAI and retained for 30 days in accordance with their privacy principles.

Please do not ask questions that use sensitive or confidential information.

Read the full Terms & Conditions.

You might also like...
New class of antihypertensive medications may have both kidney- and cardio-protective benefits