Department of Physiology, University Health Sciences Center, University of Guadalajara, Guadalajara, Jalisco, Mexico; Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico.
Department of Nephrology and Organ Transplant Unit, Specialties Hospital, National Western Medical Centre, Mexican Institute of Social Security, Guadalajara, Jalisco, Mexico.
Int J Infect Dis. 2021 Jun;107:18-24. doi: 10.1016/j.ijid.2021.04.032. Epub 2021 Apr 14.
In our population, anti-thymocyte globulin (ATG) of 1 mg/Kg/day for 4 days is used; which permits not using valgancyclovir (VGC) prophylaxis in some renal transplant recipients (RTR) with moderate risk (R+), to reduce costs. This study aimed to determine the incidence and risk of developing cytomegalovirus (CMV), with or without prophylaxis, when exposed to low doses of ATG or basiliximab (BSL).
A retrospective cohort included 265 RTR with follow-up of 12 months. Prophylaxis was used in R-/D+ and some R+. Tacrolimus (TAC), mycophenolate mofetil, and prednisone were used in all patients. Logistic regression analysis was performed to estimate the risk of CMV in RTR with or without VGC.
Cytomegalovirus was documented in 46 (17.3%) patients: 20 (43.5%) with CMV infection, and 26 (56.5%) with CMV disease. Anti-thymocyte globulin was used in 39 patients (85%): 32 R+, six D+/R-, and one D-/R-. ATG was used in 90% (27 of 30) of patients with CMV and without prophylaxis. The multivariate analysis showed an association of risk for CMV with the absence of prophylaxis (RR 2.29; 95% CI 1.08-4.86), ATG use (RR 3.7; 95% CI 1.50-9.13), TAC toxicity (RR 3.77; 95% CI 1.41-10.13), and lymphocytes at the sixth post-transplant month (RR 1.77; 95% CI 1.0-3.16).
Low doses of ATG favored the development of CMV and a lower survival free of CMV compared with BSL. In scenarios where resources for employing VGC are limited, BSL could be an acceptable strategy.
在我们的人群中，使用 1 毫克/千克/天的抗胸腺细胞球蛋白（ATG）持续 4 天；这允许一些中度风险（R+）的肾移植受者（RTR）不使用缬更昔洛韦（VGC）预防，以降低成本。本研究旨在确定在接受低剂量 ATG 或巴利昔单抗（BSL）暴露时，有无预防的情况下，巨细胞病毒（CMV）的发生率和发病风险。
一项回顾性队列研究纳入了 265 例随访 12 个月的 RTR。R-/D+和一些 R+使用预防治疗。所有患者均使用他克莫司（TAC）、霉酚酸酯和泼尼松。进行逻辑回归分析，以估计有或无 VGC 时 RTR 发生 CMV 的风险。
46 例（17.3%）患者确诊 CMV：20 例（43.5%）为 CMV 感染，26 例（56.5%）为 CMV 疾病。39 例（85%）患者使用了抗胸腺细胞球蛋白：32 例 R+，6 例 D+/R-，1 例 D-/R-。30 例使用 ATG 的患者中有 90%（27 例）无预防。多变量分析显示，无预防（RR 2.29；95%CI 1.08-4.86）、ATG 使用（RR 3.7；95%CI 1.50-9.13）、TAC 毒性（RR 3.77；95%CI 1.41-10.13）和移植后第 6 个月的淋巴细胞（RR 1.77；95%CI 1.0-3.16）与 CMV 发病风险相关。
与 BSL 相比，低剂量 ATG 更有利于 CMV 的发展，CMV 无生存获益。在资源有限的情况下，BSL 可能是一种可接受的策略。
