Comparison of prophylaxis and preemptive strategy as cytomegalovirus prevention in liver transplant recipients.
cytomegalovirus infection
liver transplantation
outcomes
preemptive strategy
prophylactic strategy
Journal
Transplant infectious disease : an official journal of the Transplantation Society
ISSN: 1399-3062
Titre abrégé: Transpl Infect Dis
Pays: Denmark
ID NLM: 100883688
Informations de publication
Date de publication:
02 Jun 2024
02 Jun 2024
Historique:
revised:
09
03
2024
received:
11
10
2023
accepted:
27
03
2024
medline:
2
6
2024
pubmed:
2
6
2024
entrez:
2
6
2024
Statut:
aheadofprint
Résumé
Prophylaxis (P) or pre-emptive strategy (PS) in high-risk liver transplant recipients (LTRs) are either recommended. We compared the results of each strategy. Two groups of LTR transplanted during two consecutive periods were compared. Only cytomegalovirus (CMV)-mismatched LTR (Donor +/ Recipient -) were included. The primary endpoints were: the onset of polymerase chain reaction-based DNAemia and the proportion of patients with CMV disease. A number of episodes of CMV infection, antiviral therapy, ganciclovir resistance, infectious or immunological complications, cost of both strategies, and survival (1, 5, and 10 years) were also compared. Forty-eight and 60 patients were respectively included in the P and PS groups. Eighteen (38%) in the P group and 56 (93%) in the PS group had CMV DNAemia (p <.0001) with a similar CMV disease rate (16.7% and 15%). Duration of curative therapy was longer in the PS group: 91 days versus 16 (p <.0001). Acute rejection was less frequent (p = .04) and more patients experienced a ganciclovir-resistant CMV infection in the PS group (10% vs. 0, p = .03). The drug-associated cost of PS was higher (10 004 vs. 4804€) and the median number of rehospitalization days tended to be higher (6 vs. 4, p = .06). Survival at any time was similar. We reported more CMV DNAemias and ganciclovir-resistant CMV events with PS. The cost of the PS strategy was higher.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14282Informations de copyright
© 2024 The Authors. Transplant Infectious Disease published by Wiley Periodicals LLC.
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