Late-onset allograft rejection, cytomegalovirus infection, and renal allograft loss: Is anti-CMV prophylaxis required following late-onset allograft rejection?

Allografts Antiviral Agents / therapeutic use Cytomegalovirus Cytomegalovirus Infections / drug therapy Graft Rejection / etiology Humans Kidney Transplantation / adverse effects Retrospective Studies Risk Factors
cytomegalovirus infection prophylaxis renal transplantation

Journal

Clinical transplantation
ISSN: 1399-0012
Titre abrégé: Clin Transplant
Pays: Denmark
ID NLM: 8710240

Informations de publication

Date de publication:
06 2021
Historique:
revised: 09 02 2021
received: 17 12 2020
accepted: 08 03 2021
pubmed: 14 3 2021
medline: 29 6 2021
entrez: 13 3 2021
Statut: ppublish

Résumé

Renal transplant recipients remain at risk of delayed-onset cytomegalovirus (CMV) infection occurring beyond a complete course of prophylaxis. In this retrospective cohort, all 278 patients who received renal allografts from deceased donors from 2014 to 2016 were followed until September 1, 2019. We determined the effect of early-vs late-onset acute rejection (EAR vs LAR [ie, occurring beyond 12 months after transplantation]) on CMV infection and subsequently long-term allograft outcome. Median (IQR) duration of follow-up was 1186.0 (904.7-1531.2) days. Seventy patients including 49 patients with EAR and 21 with LAR received augmented immunosuppression. In the same interval, 40 patients developed CMV infection (36 patients beyond 90 days after transplantation [90%]). In logistic regression analysis, D+/R- CMV serostatus (OR: 5.5, 95% CI: 2.5-12.2) and LAR (OR: 7.9, 95% CI: 2.8-22.2) significantly increased the risk of CMV infection. In Cox proportional hazard model, delayed-onset CMV infection (HR: 2.51, 95% CI: 1.08-5.86) and LAR (HR: 5.46, 95% CI: 2.26-13.14) significantly increased the risk of allograft loss. Patients with LAR are at risk of late-onset CMV infection. Post-LAR, targeted prophylaxis may reduce the risk of CMV infection and subsequently allograft loss. Further studies are required to demonstrate the effect of targeted prophylaxis following LAR.

Identifiants

DOI: 10.1111/ctr.14285 PMID: 33713374
pubmed: 33713374
doi: 10.1111/ctr.14285
doi:

Substances chimiques

Antiviral Agents 0

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

e14285

Informations de copyright

© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Références

Kotton CN, Kumar D, Caliendo AM, et al. The third international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation. 2018;102(6):900-931. https://doi.org/10.1097/TP.0000000000002191
Razonable RR, Humar A. Cytomegalovirus in solid organ transplant recipients-guidelines of the American Society of transplantation infectious diseases community of practice. Clin Transplant. 2019;33(9): https://doi.org/10.1111/ctr.13512
Razonable RR, Humar A. Cytomegalovirus in solid organ transplantation. Am J Transplant. 2013;13(s4):93-106. https://doi.org/10.1111/ajt.12103
Humar A, Limaye AP, Blumberg EA, et al. Extended valganciclovir prophylaxis in D+/R- kidney transplant recipients is associated with long-term reduction in cytomegalovirus disease: two-year results of the IMPACT study. Transplantation. 2010;90(12):1427-1431.
Azevedo LS, Pierrotti LC, Abdala E, et al. Cytomegalovirus infection in transplant recipients. Clinics. 2015;70(7):515-523. https://doi.org/10.6061/clinics/2015(07)09
Kasiske BL, Zeier MG, Chapman JR, et al. KDIGO clinical practice guideline for the care of kidney transplant recipients: a summary. Kidney Int. 2010;77(4):299-311. https://doi.org/10.1038/ki.2009.377
Joseph JT, Kingsmore DB, Junor BJR, et al. The impact of late acute rejection after cadaveric kidney transplantation. Clin Transplant. 2001;15(4):221-227. https://doi.org/10.1034/j.1399-0012.2001.150401.x
Opelz G, Döhler B. Collaborative transplant study report. Influence of time of rejection on long-term graft survival in renal transplantation. Transplantation. 2008;85(5):661-666. https://doi.org/10.1097/TP.0b013e3181661695
Sijpkens YWJ, Doxiadis IIN, Mallat MJK, et al. Early versus late acute rejection episodes in renal transplantation. Transplantation. 2003;75(2):204-208. https://doi.org/10.1097/01.TP.0000041722.34000.21
Lentine KL, Gheorghian A, Axelrod D, Kalsekar A, L'italien G, Schnitzler MA. The implications of acute rejection for allograft survival in contemporary U.S. Kidney transplantation. Transplantation. 2012;94(4):369-376. https://doi.org/10.1097/TP.0b013e318259407f
Famulski KS, Einecke G, Sis B, et al. Defining the canonical form of T-cell-mediated rejection in human kidney transplants. Am J Transplant. 2010;10(4):810-820. https://doi.org/10.1111/j.1600-6143.2009.03007.x
Sellarés J, de Freitas DG, Mengel M, et al. Understanding the causes of kidney transplant failure: the dominant role of antibody-mediated rejection and nonadherence. Am J Transplant. 2012;12(2):388-399. https://doi.org/10.1111/j.1600-6143.2011.03840.x
Razonable RR, Rivero A, Rodriguez A, et al. Allograft rejection predicts the occurrence of late-onset cytomegalovirus (CMV) disease among CMV-mismatched solid organ transplant patients receiving prophylaxis with oral ganciclovir. J Infect Dis. 2001;184(11):1461-1464. https://doi.org/10.1086/324516
Koo EH, Jang HR, Lee JE, et al. The impact of early and late acute rejection on graft survival in renal transplantation. Kidney Res Clin Pract. 2015;34(3):160-164. https://doi.org/10.1016/j.krcp.2015.06.003
Ministry of Health. Exceptional access program telephone request service reimbursement criteria; 2012. https://collections.ola.org/mon/28002/319434.pdf. Accessed May 17, 2020.
Humar A, Snydman D. Cytomegalovirus in solid organ transplant recipients. Am J Transplant. 2009;9(SUPPL. 4): https://doi.org/10.1111/j.1600-6143.2009.02897.x
Hayden CT, Preiksaitis RT, Tong J, et al. Commutability of the first World Health Organization international standard for human cytomegalovirus. J Clin Microbiol. 2015;53:3325-3333. https://doi.org/10.1128/JCM.01495-15
Berth M, Benoy I, Christensen N. Evaluation of a standardised real-time PCR based DNA-detection method (Realstar®) in whole blood for the diagnosis of primary human cytomegalovirus (CMV) infections in immunocompetent patients. Eur J Clin Microbiol Infect Dis. 2016;35(2):245-249. https://doi.org/10.1007/s10096-015-2537-0
Razonable RR, Humar A, Wilck MB, et al. Cytomegalovirus in solid organ transplantation. Am J Transplant. 2013;13(SUPPL.4):169-178. https://doi.org/10.1111/j.1600-6143.2009.02901.x
Haas M, Loupy A, Lefaucheur C, et al. The Banff 2017 kidney meeting report: revised diagnostic criteria for chronic active T cell-mediated rejection, antibody-mediated rejection, and prospects for integrative endpoints for next-generation clinical trials. Am J Transplant. 2018;18(2):293-307. https://doi.org/10.1111/ajt.14625
Browne BJ, Young J-A, Dunn TB, Matas AJ. The impact of cytomegalovirus infection ≥1 year after primary renal transplantation. Clin Transplant. 2010;24(4):572. https://doi.org/10.1111/J.1399-0012.2010.01208.X
Kliem V, Fricke L, Wollbrink T, Burg M, Radermacher J, Rohde F. Improvement in long-term renal graft survival due to CMV prophylaxis with oral ganciclovir: results of a randomized clinical trial. Am J Transplant. 2008;8(5):975-983. https://doi.org/10.1111/j.1600-6143.2007.02133.x
Liu A, Woodside KJ, Augustine JJ, Sarabu N. Racial disparity in kidney transplant survival relates to late rejection and is independent of steroid withdrawal. Clin Transplant. 2018;32(9):e13381. https://doi.org/10.1111/ctr.13381
Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant. 2009;9:S1-S155. https://doi.org/10.1111/j.1600-6143.2009.02834.x
Sola R, Alarcón A, Jiménez C, Osuna A. The influence of delayed graft function. Nephrol Dial Transpl. 2004;19 32-37. https://doi.org/10.1093/ndt/gfh1012
Gonwa TA, Mai ML, Smith LBMD, Levy MF, Goldstein RM, Klintmalm GB. Immunosuppression for delayed or slow graft function in primary cadaveric renal transplantation: use of low dose tacrolimus therapy with post-operative administration of anti-CD25 monoclonal antibody. Clin Transplant. 2002;16(2):144-149. https://doi.org/10.1034/j.1399-0012.2002.1o078.x
Knoll G, Muirhead N, Trpeski L, Zhu N, Badovinac K. Patient survival following renal transplant failure in Canada. Am J Transplant. 2005;5(7):1719-1724. https://doi.org/10.1111/j.1600-6143.2005.00921.x
Kaplan B, Meier-Kriesche H-U. Death after graft loss: an important late study endpoint in kidney transplantation. Am J Transplant. 2002;2(10):970-974. https://doi.org/10.1034/j.1600-6143.2002.21015.x
Schaubel DE, Jeffery JR, Mao Y, Semenciw R, Yeates K, Fenton SSA. Trends in mortality and graft failure for renal transplant patients. CMAJ. 2002;167(2):137.
Sedgwick P. Retrospective cohort studies: advantages and disadvantages. BMJ. 2014;348:g1072. https://doi.org/10.1136/bmj.g1072

Auteurs

Mohammadreza Rahimishahmirzadi (M)

Multiorgan Transplant Program, London Health Sciences Centre, Western University, London, ON, Canada.

Anthony M Jevnikar (AM)

Multiorgan Transplant Program, London Health Sciences Centre, Western University, London, ON, Canada.

Andrew A House (AA)

Multiorgan Transplant Program, London Health Sciences Centre, Western University, London, ON, Canada.

Patrick P Luke (PP)

Multiorgan Transplant Program, London Health Sciences Centre, Western University, London, ON, Canada.
ORCID: 0000-0002-9089-6933

Atul Humar (A)

Division of Infectious Diseases, Transplant Infectious Diseases Program, University Health Network, Toronto, ON, Canada.
Department of Medicine, University of Toronto, Toronto, ON, Canada.

Michael S Silverman (MS)

Division of Infectious Diseases, Department of Medicine, Western University, London, ON, Canada.

Sarah M Shalhoub (SM)

Multiorgan Transplant Program, London Health Sciences Centre, Western University, London, ON, Canada.
Division of Infectious Diseases, Department of Medicine, Western University, London, ON, Canada.

Seyed M Hosseini-Moghaddam (SM)

Multiorgan Transplant Program, London Health Sciences Centre, Western University, London, ON, Canada.
Division of Infectious Diseases, Department of Medicine, Western University, London, ON, Canada.
Division of Infectious Diseases, Transplant Infectious Diseases Program, University Health Network, Toronto, ON, Canada.
Department of Medicine, University of Toronto, Toronto, ON, Canada.
ORCID: 0000-0001-7979-2458

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Classifications MeSH

questionsmedicales.fr › Régions du corps › Transplants › Allogreffes › Late-onset allograft rejection,...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antiviraux › Late-onset allograft rejection,...
questionsmedicales.fr › Virus › Virus à ADN › Herpesviridae › Betaherpesvirinae › Cytomegalovirus › Late-onset allograft rejection,...
questionsmedicales.fr › Infection › Maladies virales › Infections à virus à ADN › Infections à Herpesviridae › Infections à cytomégalovirus › Late-onset allograft rejection,...
questionsmedicales.fr › Phénomènes du système immunitaire › Immunologie en transplantation › Réaction de l'hôte contre le greffon › Rejet du greffon › Late-onset allograft rejection,...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Late-onset allograft rejection,...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie urogénitale › Procédures de chirurgie urologique › Transplantation rénale › Late-onset allograft rejection,...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Late-onset allograft rejection,...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Facteurs de risque › Late-onset allograft rejection,...