JOSE OTTO REUSING JUNIOR
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
1 resultados
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- Cytomegalovirus prophylaxis in seropositive renal transplant recipients receiving thymoglobulin induction therapy: Outcome and risk factors for late CMV disease(2018) JR, Jose O. Reusing; FEITOSA, Emanoela B.; AGENA, Fabiana; PIERROTTI, Ligia C.; AZEVEDO, Luiz S. F.; KOTTON, Camille N.; DAVID-NETO, EliasBackgroundAnti-thymocyte globulin (ATG) therapy is a risk factor for cytomegalovirus (CMV) disease in renal transplant (RTx) recipients and therefore antiviral prophylaxis is commonly used. We evaluated the outcome of our current policy of 90days of CMV prophylaxis in seropositive recipients given ATG and the risk factors for the occurrence of CMV disease after prophylaxis. MethodsWe studied a retrospective cohort of 423 RTx (2010-2014) CMV-seropositive adults given ATG induction therapy. Results54 (13%) patients developed CMV disease at a median of 163days after transplant, of which 29 (54%) had viral syndrome and 25 (46%) had invasive disease. Median prophylaxis time (94days) and immunosuppressive drugs were similar between groups (CMV vs no-CMV). Those with CMV disease had more deceased donors and higher donor age, lower lymphocyte count, and lower median eGFR at day 90. Multivariable logistic regression analysis at day 90 and 180 found that eGFR 40ml/min/1.73m(2) (but not acute rejection) was associated with late CMV disease. In a separate validation cohort of 124 patients with 8% late CMV disease, eGFR 45 and lymphocyte count 800cells/mm(3) at the end of prophylaxis remained predictive of late CMV disease occurrence. ConclusionsThese data indicate that antiviral prophylaxis adequately prevented CMV in seropositive recipients given ATG, but late disease still occurred. Low eGFR and low lymphocyte count at the end of prophylaxis may help identify patients at higher risk of CMV disease.