Survey of cytomegalovirus infection in kidney transplant recipients

CILJ. Utvrditi povezanost citomegalovirusne (CMV) infekcije u bolesnika s bubrežnim presatkom s praćenjem citomegalovirusne deoksiribonukleinske kiseline (DNA) i profilaksom valganciklovirom. ISPITANICI I POSTUPCI. Uključeno je bilo 107 ispitanika s bubrežnim presatkom, transplantiranih u Kliničkom bolničkom centru Osijek od 20. 10. 2007. do 24. 8. 2016., 60 muških, medijana dobi u vrijeme transplantacije (TX) 51 godinu, 27 - 71, a praćenja 4 godine, 0 - 9. Podaci su preuzeti iz medicinskih zapisa te statistički obrađeni pomoću SPSS-a (inačica 16.0). REZULTATI. Transplantiranih je 92,5 % bilo pozitivno na CMV IgG prije TX-a, a 86 % darovatelja. Dvadesetosam posto ih je u jednom trenutku nakon TX-a bilo pozitivno na CMV-DNA, od toga nikada nijedan primatelj CMV IgG negativnog darovatelja. Profilaksa je primijenjena u 89,7 % bolesnika. Sedam bolesnika imalo je klinički očitovanu infekciju. Bolesnicima je jednom godišnje (medijan) određivan CMV-DNA (od 0 do 6). Nije pronađena značajna razlika u učestalosti viremije između bolesnika s i bez profilakse, ali je klinički očitovana infekcija bila granično značajno češća u onih bez profilakse (P = 0,066). ZAKLJUČAK. Prevalencija pozitivnosti na CMV IgG bila je velika. Profilaksa valganciklovirom nije bila statistički značajna za razvoj viremije u bolesnika s bubrežnim presatkom, a zaštitni čimbenik bio je IgG negativan darovatelj. Pozitivitet na CMV-DNA bio je relativno velik, a klinički očitovana infekcija rijetka i većinom blaga, što bi se ipak moglo pripisati profilaksi. Uputno bi bilo primjenjivati profilaksu valganciklovirom i protokolarno određivati CMV-DNA radi pravodobnog otkrivanja viremije, preemptivnog liječenja, sprječavanja kliničkog očitovanja infekcije i očuvanja funkcije presatka.OBJECTIVES. To examine the relationship of cytomegalovirus (CMV) viremia and infection in kidney transplant recipients with regular testing for CMV deoxyribonucleic acid (DNA) and with CMV prophylaxis with oral valganciclovir. PARTICIPANTS AND METHODS. Study included 107 kidney recipients transplanted at Clinical Hospital Centre Osijek in the period October 20, 2007 - August 24, 2016, out of whom 60 were male. Median age at the time of transplantation (TX) was 51 years (27 - 71). Median follow-up of kidney transplant was 4 years (from 0 to 9). The data were taken from medical records and statistically analyzed in SPSS (version 16.0). RESULTS. 92.5 % of kidney recipients and 86 % of donors were CMV IgG positive before TX. 28 % of participants were CMV-DNA positive at some point after TX, none of whom from an IgG negative donor. 89.7 % of participants received CMV prophylaxis. Seven patients had clinically manifested infection. The participants were tested for CMV-DNA once a year (median; from 0 to 6 times). There was no significant difference in CMV-DNA positivity occurrence between participants having received prophylaxis and those who have not, but the clinically manifested infection was marginally more frequent in those who have not (P = 0.066). CONCLUSION. There was a high prevalence of CMV IgG positivity in kidney donors and recipients. Valganciclovir prophylaxis had no significant impact on the development of CMV viremia and infection, and donor CMV IgG negativity was a protective factor. The incidence of CMV-DNA positivity during follow-up was relatively high, while clinically manifested infection was rare and mostly mild, which could be, however, related to the usage of prophylaxis. It is wise to enforce CMV prophylaxis and CMV-DNA testing per protocol to discover viremia on time and to implement preemptive treatment, aiming at prevention of clinically manifested infection and preserving the kidney transplant function