Cytomegalovirus prevention strategies and the risk of BK polyomavirus viremia and nephropathy.
Adult
BK Virus
Cytomegalovirus
Cytomegalovirus Infections
/ prevention & control
Female
Graft Survival
Humans
Kidney Failure, Chronic
/ complications
Kidney Transplantation
/ adverse effects
Male
Middle Aged
Multivariate Analysis
Polyomavirus Infections
/ virology
Premedication
Proportional Hazards Models
Prospective Studies
Randomized Controlled Trials as Topic
Risk Factors
Treatment Outcome
Tumor Virus Infections
/ prevention & control
Valacyclovir
/ therapeutic use
Valganciclovir
/ therapeutic use
Viremia
/ etiology
clinical research/practice
clinical trial
infection and infectious agents - viral: BK/JC/polyoma
infection and infectious agents - viral: cytomegalovirus (CMV)
infectious disease
kidney transplantation/nephrology
Journal
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
ISSN: 1600-6143
Titre abrégé: Am J Transplant
Pays: United States
ID NLM: 100968638
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
07
04
2019
revised:
11
06
2019
accepted:
13
06
2019
pubmed:
21
6
2019
medline:
24
9
2020
entrez:
21
6
2019
Statut:
ppublish
Résumé
Polyomavirus BK (BKV) is the cause of polyomavirus-associated nephropathy resulting in premature graft loss. There are limited data regarding the role of cytomegalovirus (CMV) infection and its prevention in developing BKV viremia and PVAN. In a prospective study, we analyzed 207 consecutive renal transplant recipients previously enrolled in 2 randomized trials evaluating different CMV prevention regimens with routine screening for BKV and CMV. Of these, 59 received valganciclovir and 100 valacyclovir prophylaxis; 48 patients were managed by preemptive therapy. At 3 years, the incidence of BKV viremia and PVAN was 28% and 5%, respectively. CMV DNAemia developed in 55% and CMV disease in 6%. Both BKV viremia (42% vs 23% vs 21%, P = .006) and PVAN (12% vs 2% vs 2%, P = .011) were increased in patients treated with valganciclovir prophylaxis compared to valacyclovir and preemptive therapy. Using multivariate Cox proportional hazard regression, valganciclovir prophylaxis was independent predictor of BKV viremia (hazard ratio [HR] = 2.38, P = .002) and PVAN (HR = 4.73, P = .026). In contrast, the risk of subsequent BKV viremia was lower in patients with antecedent CMV DNAemia (HR = 0.50, P = .018). These data suggest valganciclovir prophylaxis may be associated with increased risk of BKV viremia and PVAN. CMV DNAemia did not represent a risk for BKV.
Identifiants
pubmed: 31220412
doi: 10.1111/ajt.15507
pii: S1600-6135(22)09221-8
doi:
Substances chimiques
Valganciclovir
GCU97FKN3R
Valacyclovir
MZ1IW7Q79D
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2457-2467Subventions
Organisme : National Sustainability Program I
ID : LO1503
Pays : International
Organisme : Ministry of Education, Youth and Sports of the Czech Republic
Pays : International
Organisme : Charles University Research Fund
Pays : International
Organisme : Fighting INfectious Diseases
ID : CZ.02.1.01/0.0/0.0/16_019/0000787
Pays : International
Organisme : European Regional Development Fund
Pays : International
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.
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