Reduction in mortality associated with secondary cytomegalovirus prophylaxis after solid organ transplantation
Serrano-Alonso M (1), Guillen-Grima F (2,3,4), Martin-Moreno P (4,5), Rabago G (6), Manrique J (4,7), Garcia-Del-Barrio M (1), Reina G (4,8), Torre-Cisneros J (9), Fernandez-Alonso M (4,8), Herrero JI (4,10,11).
(1) Pharmacy Department, Clínica Universidad de Navarra, Pamplona, Spain.
(2) Preventive Medicine Department, Clínica Universidad de Navarra, Pamplona, Spain.
(3) Department of Health Sciences, Public University of Navarra, Pamplona, Spain.
(4) Navarra's Health Research Institute (IdiSNA), Pamplona, Spain.
(5) Nephrology Department, Clínica Universidad de Navarra, Pamplona, Spain.
(6) Cardiac Surgery Department, Clínica Universidad de Navarra, Pamplona, Spain.
(7) Nephrology Department, Complejo Hospitalario de Navarra, Pamplona, Spain.
(8) Microbiology Department, Clínica Universidad de Navarra, Pamplona, Spain.
(9) Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, University of Cordoba, Cordoba, Spain.
(10) Liver Unit, Clínica Universidad de Navarra, Pamplona, Spain.
(11) Biomedical Research Networking Center in Hepatic and Digestive Diseases (CIBERehd), Madrid, Spain.
Cytomegalovirus (CMV) is the most important viral pathogen in solid organ transplant (SOT) recipients. The role of secondary CMV prophylaxis in this population remains unclear.
Retrospective cohort study in a single center. SOT recipients treated for CMV infection from 2007 to 2014 were studied to determine the efficacy and safety of secondary prophylaxis and its impact on graft loss and mortality. The outcome variable was CMV replication in the first 3 months after the end of therapy. Secondary variables were crude mortality and graft lost censored at 5 years after transplantation. Propensity score for the use of secondary prophylaxis was used to control selection bias.
Of the 126 treated patients, 103 (83.1%) received CMV secondary prophylaxis. CMV relapse occurred in 44 (35.5%) patients. The use of secondary prophylaxis was not associated with fewer relapses (34.0% in patients with prophylaxis vs 42.9% in those without prophylaxis, P = .29). After a mean follow-up of 32.1 months, graft loss was not different between both groups but patient mortality was significantly lower in patients who received secondary prophylaxis (5.8% vs 28.6%, P = .003).
Secondary prophylaxis did not prevent CMV infection relapse but it was associated with improved patient survival.
CITATION Transpl Infect Dis. 2018 Jun;20(3):e12873. doi: 10.1111/tid.12873. Epub 2018 Mar 30