Comparison of prophylaxis and preemptive strategy as cytomegalovirus prevention in liver transplant recipients
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View abstract on PubMed
Summary
This summary is machine-generated.Prophylaxis (P) is recommended over a pre-emptive strategy (PS) for high-risk liver transplant recipients (LTRs) with cytomegalovirus (CMV) mismatch. PS led to more CMV DNAemias and resistant infections, with higher costs and no survival benefit.
Area Of Science
- Hepatology
- Transplant Surgery
- Infectious Diseases
Background
- Cytomegalovirus (CMV) prophylaxis strategies are debated for high-risk liver transplant recipients (LTRs).
- CMV-mismatched LTRs (Donor +/ Recipient -) require careful management to prevent complications.
Purpose Of The Study
- To compare the outcomes of prophylaxis (P) versus a pre-emptive strategy (PS) for CMV in high-risk LTRs.
- To evaluate CMV DNAemia, disease incidence, antiviral therapy, resistance, complications, costs, and survival between the two strategies.
Main Methods
- A comparative study of two LTR groups (P vs. PS) transplanted consecutively.
- Inclusion criteria: CMV-mismatched LTRs.
- Primary endpoints: CMV DNAemia onset and CMV disease proportion. Secondary endpoints: infection episodes, antiviral use, resistance, complications, costs, and survival.
Main Results
- Higher CMV DNAemia rates in the PS group (93% vs. 38% in P group; p <.0001).
- Similar CMV disease rates (15% vs. 16.7%).
- Longer antiviral therapy duration, more ganciclovir-resistant CMV infections, and higher costs associated with the PS strategy.
Conclusions
- The pre-emptive strategy (PS) resulted in more CMV DNAemias and ganciclovir-resistant infections compared to prophylaxis (P).
- PS was associated with increased costs and longer treatment durations without improving survival.
- Prophylaxis (P) may be a more favorable strategy for CMV management in high-risk LTRs.
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