Low dose thymoglobulin versus basiliximab in cytomegalovirus positive kidney transplant recipients: Effectiveness of preemptive cytomegalovirus modified strategy
Background: We performed a retrospective trial to determine asymptomatic CMV reactivation and CMV disease in kidney allograft recipients with positive CMV serostatus. Methods: Preemptive modified strategy under low dose thymoglobulin versus basiliximab induction was evaluated. Patients were monitore...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | Spanish |
| Published: |
Elsevier
2023-03-01
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| Series: | Nefrología |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0211699521002368 |
| _version_ | 1827980808832417792 |
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| author | Camilo Montero Nancy Yomayusa Rodolfo Torres Jorge Cortes Carlos Alvarez Juan Gallo Guillermo Aldana Andres Acevedo Maria Rios Johana Echeverri Zuly Yepes Adriana Silva Diana Gayon Jorge Perez Milciades Ibanez |
| author_facet | Camilo Montero Nancy Yomayusa Rodolfo Torres Jorge Cortes Carlos Alvarez Juan Gallo Guillermo Aldana Andres Acevedo Maria Rios Johana Echeverri Zuly Yepes Adriana Silva Diana Gayon Jorge Perez Milciades Ibanez |
| author_sort | Camilo Montero |
| collection | DOAJ |
| description | Background: We performed a retrospective trial to determine asymptomatic CMV reactivation and CMV disease in kidney allograft recipients with positive CMV serostatus. Methods: Preemptive modified strategy under low dose thymoglobulin versus basiliximab induction was evaluated. Patients were monitored by CMV-polymerase chain reaction (PCR); if the viral load was >4000 copies/μl, they received valganciclovir adjusted for their renal function. Results: 132 recipients were included in the study, 84 and 48 receiving basiliximab and thymoglobulin induction respectively, and followed up for 12 months. Asymptomatic CMV reactivation was significantly higher for thymoglobulin (77.1% vs. 16.7%, p < 0.001). Treatment groups had similar rates of CMV disease (3.6% vs. 2.1%, p 0.538). The significant difference in asymptomatic CMV reactivation between two treatment groups did not have any impact on 1 year graft function (71 ± 26 ml/min vs. 74 ± 19 ml/min; p = 0.475) and no histological differences in protocol biopsies were observed among patients with asymptomatic CMV reactivation vs those without CMV reactivation. Conclusions: Due to the high asymptomatic CMV reactivation incidence in patients who received thymoglobulin induction, our results suggest that valganciclovir prophylaxis may be advantageous in CMV seropositive renal transplant recipients after low dose thymoglobulin induction. A preemptive strategy appeared to significantly reduce the likelihood of CMV disease in both groups. Rejection risk and negative impact in renal function associated with asymptomatic CMV reactivation was not found in our series. Resumen: Antecedentes: Llevamos a cabo un estudio retrospectivo para determinar la reactivación y enfermedad por CMV en receptores de trasplante renal CMV seropositivos bajo diferentes esquemas de inducción. Métodos: Una estrategia preventiva modificada bajo inducción con basiliximab y timoglobulina en dosis bajas fue evaluada. Se llevó a cabo un seguimiento de la carga viral-reacción de cadena de la polimerasa-CMV; los valores mayores de 4000 copias/μl recibieron valganciclovir ajustado a la función renal. Resultados: Un total de 132 receptores de trasplante renal fueron incluidos; 84 y 48 recibieron inducción con basiliximab y timoglobulina respectivamente. Seguimiento hasta el mes 12 postrasplante. La reactivación asintomática de CMV fue significativamente mayor para timoglobulina (77,1% vs. 16,7%, p < 0,001). La tasa de enfermedad por CMV fue similar en ambos grupos de tratamiento (3,6% vs. 2,1%, p = 0,538). Ningún impacto en la función renal un año postrasplante fue encontrado entre los grupos a pesar de la diferencia significativa en reactivación asintomática de CMV (71 ± 26 ml/min vs. 74 ± 19 ml/min; p = 0,475); igualmente, no encontramos diferencias en los hallazgos histológicos en biopsias por protocolo entre receptores con reactivación asintomática por CMV y aquellos sin reactivación. Conclusiones: La alta incidencia de reactivación asintomática por CMV en receptores seropositivos a pesar del uso de bajas dosis de timoglobulina sugiere que la profilaxis con valganciclovir es una estrategia apropiada en este grupo; sin embargo, una estrategia preventiva reduce significativamente la probabilidad de enfermedad por CMV en ambos grupos de tratamiento. El riesgo de rechazo y el impacto negativo en la función renal asociado a la reactivación asintomática por CMV no fue encontrado en nuestra experiencia. |
| first_indexed | 2024-04-09T21:57:54Z |
| format | Article |
| id | doaj.art-d8529eaef3ef4f70a2e3a056085bfb54 |
| institution | Directory Open Access Journal |
| issn | 0211-6995 |
| language | Spanish |
| last_indexed | 2024-04-09T21:57:54Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Nefrología |
| spelling | doaj.art-d8529eaef3ef4f70a2e3a056085bfb542023-03-24T04:21:47ZspaElsevierNefrología0211-69952023-03-01432213223Low dose thymoglobulin versus basiliximab in cytomegalovirus positive kidney transplant recipients: Effectiveness of preemptive cytomegalovirus modified strategyCamilo Montero0Nancy Yomayusa1Rodolfo Torres2Jorge Cortes3Carlos Alvarez4Juan Gallo5Guillermo Aldana6Andres Acevedo7Maria Rios8Johana Echeverri9Zuly Yepes10Adriana Silva11Diana Gayon12Jorge Perez13Milciades Ibanez14Renal Transplantation Group, Clinica Reina Sofia, University Clinic, Bogota, Colombia; Translational Investigation Group, Sanitas University, Clinica Colsanitas, Bogota, Colombia; Corresponding author.Renal Transplantation Group, Clinica Reina Sofia, University Clinic, Bogota, Colombia; Translational Investigation Group, Sanitas University, Clinica Colsanitas, Bogota, Colombia; Infectious Diseases Department, Clinica Colsanitas, Bogota, ColombiaRenal Transplantation Group, Clinica Reina Sofia, University Clinic, Bogota, Colombia; Translational Investigation Group, Sanitas University, Clinica Colsanitas, Bogota, ColombiaFacultad de Medicina, Universidad Nacional de ColombiaTranslational Investigation Group, Sanitas University, Clinica Colsanitas, Bogota, Colombia; Infectious Diseases Department, Clinica Colsanitas, Bogota, ColombiaRenal Transplantation Group, Clinica Reina Sofia, University Clinic, Bogota, ColombiaRenal Transplantation Group, Clinica Reina Sofia, University Clinic, Bogota, ColombiaRenal Transplantation Group, Clinica Reina Sofia, University Clinic, Bogota, Colombia; Translational Investigation Group, Sanitas University, Clinica Colsanitas, Bogota, ColombiaMolecular Biology and Immunology Laboratory, Clinica Colsanitas, Bogota, ColombiaMolecular Biology and Immunology Laboratory, Clinica Colsanitas, Bogota, ColombiaMolecular Biology and Immunology Laboratory, Clinica Colsanitas, Bogota, ColombiaRenal Transplantation Group, Clinica Reina Sofia, University Clinic, Bogota, ColombiaRenal Transplantation Group, Clinica Reina Sofia, University Clinic, Bogota, ColombiaRenal Transplantation Group, Clinica Reina Sofia, University Clinic, Bogota, Colombia; Translational Investigation Group, Sanitas University, Clinica Colsanitas, Bogota, Colombia; Infectious Diseases Department, Clinica Colsanitas, Bogota, Colombia; Molecular Biology and Immunology Laboratory, Clinica Colsanitas, Bogota, ColombiaRenal Transplantation Group, Clinica Reina Sofia, University Clinic, Bogota, Colombia; Translational Investigation Group, Sanitas University, Clinica Colsanitas, Bogota, ColombiaBackground: We performed a retrospective trial to determine asymptomatic CMV reactivation and CMV disease in kidney allograft recipients with positive CMV serostatus. Methods: Preemptive modified strategy under low dose thymoglobulin versus basiliximab induction was evaluated. Patients were monitored by CMV-polymerase chain reaction (PCR); if the viral load was >4000 copies/μl, they received valganciclovir adjusted for their renal function. Results: 132 recipients were included in the study, 84 and 48 receiving basiliximab and thymoglobulin induction respectively, and followed up for 12 months. Asymptomatic CMV reactivation was significantly higher for thymoglobulin (77.1% vs. 16.7%, p < 0.001). Treatment groups had similar rates of CMV disease (3.6% vs. 2.1%, p 0.538). The significant difference in asymptomatic CMV reactivation between two treatment groups did not have any impact on 1 year graft function (71 ± 26 ml/min vs. 74 ± 19 ml/min; p = 0.475) and no histological differences in protocol biopsies were observed among patients with asymptomatic CMV reactivation vs those without CMV reactivation. Conclusions: Due to the high asymptomatic CMV reactivation incidence in patients who received thymoglobulin induction, our results suggest that valganciclovir prophylaxis may be advantageous in CMV seropositive renal transplant recipients after low dose thymoglobulin induction. A preemptive strategy appeared to significantly reduce the likelihood of CMV disease in both groups. Rejection risk and negative impact in renal function associated with asymptomatic CMV reactivation was not found in our series. Resumen: Antecedentes: Llevamos a cabo un estudio retrospectivo para determinar la reactivación y enfermedad por CMV en receptores de trasplante renal CMV seropositivos bajo diferentes esquemas de inducción. Métodos: Una estrategia preventiva modificada bajo inducción con basiliximab y timoglobulina en dosis bajas fue evaluada. Se llevó a cabo un seguimiento de la carga viral-reacción de cadena de la polimerasa-CMV; los valores mayores de 4000 copias/μl recibieron valganciclovir ajustado a la función renal. Resultados: Un total de 132 receptores de trasplante renal fueron incluidos; 84 y 48 recibieron inducción con basiliximab y timoglobulina respectivamente. Seguimiento hasta el mes 12 postrasplante. La reactivación asintomática de CMV fue significativamente mayor para timoglobulina (77,1% vs. 16,7%, p < 0,001). La tasa de enfermedad por CMV fue similar en ambos grupos de tratamiento (3,6% vs. 2,1%, p = 0,538). Ningún impacto en la función renal un año postrasplante fue encontrado entre los grupos a pesar de la diferencia significativa en reactivación asintomática de CMV (71 ± 26 ml/min vs. 74 ± 19 ml/min; p = 0,475); igualmente, no encontramos diferencias en los hallazgos histológicos en biopsias por protocolo entre receptores con reactivación asintomática por CMV y aquellos sin reactivación. Conclusiones: La alta incidencia de reactivación asintomática por CMV en receptores seropositivos a pesar del uso de bajas dosis de timoglobulina sugiere que la profilaxis con valganciclovir es una estrategia apropiada en este grupo; sin embargo, una estrategia preventiva reduce significativamente la probabilidad de enfermedad por CMV en ambos grupos de tratamiento. El riesgo de rechazo y el impacto negativo en la función renal asociado a la reactivación asintomática por CMV no fue encontrado en nuestra experiencia.http://www.sciencedirect.com/science/article/pii/S0211699521002368Infeccion por cytomegalovirusTrasplante renalTimoglobulinaBasiliximabFuncion del injertoHistologia renal |
| spellingShingle | Camilo Montero Nancy Yomayusa Rodolfo Torres Jorge Cortes Carlos Alvarez Juan Gallo Guillermo Aldana Andres Acevedo Maria Rios Johana Echeverri Zuly Yepes Adriana Silva Diana Gayon Jorge Perez Milciades Ibanez Low dose thymoglobulin versus basiliximab in cytomegalovirus positive kidney transplant recipients: Effectiveness of preemptive cytomegalovirus modified strategy Nefrología Infeccion por cytomegalovirus Trasplante renal Timoglobulina Basiliximab Funcion del injerto Histologia renal |
| title | Low dose thymoglobulin versus basiliximab in cytomegalovirus positive kidney transplant recipients: Effectiveness of preemptive cytomegalovirus modified strategy |
| title_full | Low dose thymoglobulin versus basiliximab in cytomegalovirus positive kidney transplant recipients: Effectiveness of preemptive cytomegalovirus modified strategy |
| title_fullStr | Low dose thymoglobulin versus basiliximab in cytomegalovirus positive kidney transplant recipients: Effectiveness of preemptive cytomegalovirus modified strategy |
| title_full_unstemmed | Low dose thymoglobulin versus basiliximab in cytomegalovirus positive kidney transplant recipients: Effectiveness of preemptive cytomegalovirus modified strategy |
| title_short | Low dose thymoglobulin versus basiliximab in cytomegalovirus positive kidney transplant recipients: Effectiveness of preemptive cytomegalovirus modified strategy |
| title_sort | low dose thymoglobulin versus basiliximab in cytomegalovirus positive kidney transplant recipients effectiveness of preemptive cytomegalovirus modified strategy |
| topic | Infeccion por cytomegalovirus Trasplante renal Timoglobulina Basiliximab Funcion del injerto Histologia renal |
| url | http://www.sciencedirect.com/science/article/pii/S0211699521002368 |
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