Department of Nephrology, Oslo University Hospital, Ullevål, Oslo, Norway.
Institute for Experimental Medical Research, KG Jebsen Center for Cardiac Research, Oslo University Hospital, Ullevål and University of Oslo, Oslo, Norway.
Transplantation. 2023 Aug 1;107(8):1846-1853. doi: 10.1097/TP.0000000000004615. Epub 2023 Jul 20.
Following kidney transplantation (KT), cytomegalovirus (CMV) infection remains an important challenge. Both prophylactic and preemptive antiviral protocols are used for CMV high-risk kidney recipients (donor seropositive/recipient seronegative; D+/R-). We performed a nationwide comparison of the 2 strategies in de novo D+/R- KT recipients accessing long-term outcomes.
A nationwide retrospective study was conducted from 2007 to 2018, with follow-up until February 1, 2022. All adult D+/R- and R+ KT recipients were included. During the first 4 y, D+/R- recipients were managed preemptively, changing to 6 mo of valganciclovir prophylaxis from 2011. To adjust for the 2 time eras, de novo intermediate-risk (R+) recipients, who received preemptive CMV therapy throughout the study period, served as longitudinal controls for possible confounders.
A total of 2198 KT recipients (D+/R-, n = 428; R+, n = 1770) were included with a median follow-up of 9.4 (range, 3.1-15.1) y. As expected, a greater proportion experienced a CMV infection in the preemptive era compared with the prophylactic era and with a shorter time from KT to CMV infection ( P < 0.001). However, there were no differences in long-term outcomes such as patient death (47/146 [32%] versus 57/282 [20%]; P = 0.3), graft loss (64/146 [44%] versus 71/282 [25%]; P = 0.5), or death censored graft loss (26/146 [18%] versus 26/282 [9%]; P = 0.9) in the preemptive versus prophylactic era. Long-term outcomes in R+ recipients showed no signs of sequential era-related bias.
There were no significant differences in relevant long-term outcomes between preemptive and prophylactic CMV-preventive strategies in D+/R- kidney transplant recipients.
肾移植（KT）后，巨细胞病毒（CMV）感染仍然是一个重要的挑战。对于 CMV 高危肾移植受者（供体血清阳性/受体血清阴性；D+/R-），既可以采用预防性抗病毒方案，也可以采用抢先性抗病毒方案。我们在接受长期随访的新诊断 D+/R- KT 受者中，对这两种策略进行了全国性比较。
这是一项全国性的回顾性研究，于 2007 年至 2018 年进行，随访至 2022 年 2 月 1 日。所有成年 D+/R-和 R+ KT 受者均被纳入研究。在最初的 4 年内，D+/R-受者采用抢先性治疗策略，自 2011 年起改为 6 个月的缬更昔洛韦预防方案。为了调整这两个时期，新诊断的中危（R+）受者在整个研究期间接受抢先性 CMV 治疗，作为可能混杂因素的纵向对照。
共纳入 2198 例 KT 受者（D+/R-，n=428；R+，n=1770），中位随访时间为 9.4（范围：3.1-15.1）年。与预防性方案相比，抢先性方案的 CMV 感染比例更高，且从 KT 到 CMV 感染的时间更短（P<0.001），这是符合预期的。然而，在患者死亡（47/146[32%]比 57/282[20%]；P=0.3）、移植物丢失（64/146[44%]比 71/282[25%]；P=0.5）或死亡合并移植物丢失（26/146[18%]比 26/282[9%]；P=0.9）等长期结局方面，抢先性方案与预防性方案之间并无差异。R+受者的长期结局没有表现出与连续时代相关的偏差迹象。
在新诊断 D+/R-肾移植受者中，抢先性和预防性 CMV 预防策略在相关长期结局方面并无显著差异。
