Strategies Offer Similar Protection from CMV Disease

SEATTLE—Antiviral prophylaxis and preemptive therapy are similarly effective in preventing cytomegalovirus (CMV) disease in solid organ transplant (SOT) recipients, investigators reported at the 2013 American Transplant Congress.

Oriol Manuel, MD, of the Transplantation Center, University Hospital of Lausanne in Switzerland, and colleagues enrolled 1,239 SOT recipients, of whom 466 (38%) had received CMV prophylaxis and 522 (42%) were treated preemptively. The study population had 83 episodes of CMV disease (including 13 episodes of proven end-organ disease) in 75 patients (6%). Study results showed that CMV incidence was linked to CMV serostatus. Seronegative recipients who had a seropositive donor had a significant fivefold increase risk of CMV disease compared with seropositive recipients.

After excluding patients with missing serostatus information, the researchers found no significant difference in the incidence of CMV disease between the patients in the prophylaxis or preemptive therapy groups overall or among seropositive recipients (intermediate-risk patients) or seronegative recipients who had a seropositive donor (high-risk patients). CMV disease was not associated with a lower graft failure-free survival, but patients managed with preemptive therapy had a significant 63% increased likelihood of graft failure after a median of 1.05 years of follow-up, according to the investigators.

“We found a high graft failure-free survival in patients receiving antiviral prophylaxis, most likely due to better control of early-onset viremia,” the authors concluded in a poster presentation.

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