Merck & Co., Inc., Kenilworth, NJ, United States.
Evidera, Bethesda, MD, United States.
Transpl Int. 2022 Aug 12;35:10528. doi: 10.3389/ti.2022.10528. eCollection 2022.
Limited data exist on cytomegalovirus (CMV) antiviral treatment patterns among kidney transplant recipients (KTRs). Using United States Renal Database System registry data and Medicare claims (1 January 2011-31 December 2017), we examined CMV antiviral use in 22,878 KTRs who received their first KT from 2011 to 2016. Three-quarters of KTRs started CMV prophylaxis (85.8% of high-, 82.4% of intermediate-, and 32.1% of low-risk KTRs). Median time to prophylaxis discontinuation was 98, 65, and 61 days for high-, intermediate-, and low-risk KTRs, respectively. Factors associated with receiving CMV prophylaxis were high-risk status, diabetes, receipt of a well-functioning kidney graft, greater time on dialysis before KT, panel reactive antibodies ≥80%, and use of antithymocyte globulin, alemtuzumab, and tacrolimus. KTRs were more likely to discontinue CMV prophylaxis if they developed leukopenia/neutropenia, had cardiovascular disease, or received their kidney from a deceased donor. These findings suggest that adherence to the recommended duration of CMV-prophylaxis for high and intermediate-risk patients is suboptimal, and CMV prophylaxis is overused in low-risk patients.
有关肾移植受者（KTR）中巨细胞病毒（CMV）抗病毒治疗模式的数据有限。我们使用美国肾脏数据库系统登记数据和医疗保险索赔（2011 年 1 月 1 日至 2017 年 12 月 31 日），研究了 2011 年至 2016 年间接受首次 KT 的 22878 名 KTR 中 CMV 抗病毒药物的使用情况。四分之三的 KTR 开始进行 CMV 预防（高危 KTR 为 85.8%，中危 KTR 为 82.4%，低危 KTR 为 32.1%）。高危、中危和低危 KTR 的预防用药中位停药时间分别为 98、65 和 61 天。与接受 CMV 预防相关的因素包括高危状态、糖尿病、接受功能良好的肾脏移植物、接受 KT 前透析时间更长、Panel 反应性抗体≥80%以及使用抗胸腺细胞球蛋白、阿仑单抗和他克莫司。如果 KTR 发生白细胞减少/中性粒细胞减少、患有心血管疾病或接受已故供者的肾脏，则更有可能停止 CMV 预防。这些发现表明，对于高危和中危患者，CMV 预防的建议持续时间的依从性并不理想，并且在低危患者中 CMV 预防被过度使用。
