Background: Immunosuppressive and antivira[ prophy[
actic drugs are needed to prevent acute rejection
and infection after organ transplantation.
We assessed the effectiveness of a new combined
regimen introduced at our transplantation center.
Methods: We reviewed at[ consecutive patients
who underwent kidney transplantation at our institution
over a 5.5-year period, with a follow-up
of at [east 6 months. Patients transplanted from
1/2000 to 3/2003 (Period 1) were compared to
patients transplanted from 4/2003 to 7/2005 (Period
2). In period 1, patients were treated with
Basi[iximab, Cic[osporin, steroids and Mycophenotate
or Azathioprine. Prophylaxis with Va[acic[
ovir was prescribed in CMV D+/R- patients; otherwise,
a preemptive antivira[ approach was used.
In period 2, immunosuppressive drugs were Basi[-
iximab, Tacro[imus, steroids and Mycopheno[ate.
A 3-month CMV prophylaxis with Va[gancic[ovir was
used, except in D-/R- patients.
Results: Sixty-three patients were transplanted in
period 1 and 70 patients in period 2. Baseline
characteristics of both groups were comparable;
in particular 17% of patients were CMV D+/R- in
period 1 compared to 23% in period 2 (p=0.67).
Acute rejection was more frequent in period 1
than in period 2 (40% of patients vs 7%, respectively
p<0.001). Nineteen patients (30%) in period
1 were diagnosed with CMV infection/disease
that required treatment, compared with 8 patients
(11.4%) in period 2 (p = 0.003). Of these 8 patients,
at[ had CMV infection/disease after discontinuation
of Va[gancic[ovir prophylaxis, 6 were D+/R- (75%),
and at[ were treated with oral Va[gancic[ovir. There
was no difference between periods in terms of
incidence of BK nephropathy, post-transplant [ymphopro[
iferative disease, graft toss, and mortality.
Conclusions: These results indicate that a 3-month
course of oral Va[gancic[ovir is very effective to
prevent CMV infection/disease in kidney transplantation.
Late-onset CMV disease is a residual problem
in D+/R- patients receiving VGC prophylaxis.