Efficacy and safety of universal valganciclovir prophylaxis combined with a tacrolimus/mycophenolate-based regimen in kidney transplantation.

Details

Serval ID
serval:BIB_560BC968AC2D
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Efficacy and safety of universal valganciclovir prophylaxis combined with a tacrolimus/mycophenolate-based regimen in kidney transplantation.
Journal
Swiss medical weekly
Author(s)
Manuel O., Venetz J.P., Fellay J., Wasserfallen J.B., Sturzenegger N., Fontana M., Matter M., Meylan P.R., Pascual M.
ISSN
1424-7860 (Print)
ISSN-L
0036-7672
Publication state
Published
Issued date
01/12/2007
Peer-reviewed
Oui
Volume
137
Number
47-48
Pages
669-676
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
Immunosuppressive and antiviral prophylactic drugs are needed to prevent acute rejection and infection after transplantation. We assessed the efficacy and safety of the introduction of universal valganciclovir prophylaxis in combination with a tacrolimus/mycophenolate-based regimen in kidney transplantation at our centre.
We reviewed all consecutive patients who underwent kidney transplantation over a 5.5-year period. Patients transplanted from January 2000 to March 2003 (period 1) were compared to patients from April 2003 to July 2005 (period 2). In period 1 patients were treated with basiliximab, cyclosporine, steroids and mycophenolate (or azathioprine). Prophylaxis with valacyclovir was prescribed in cytomegalovirus (CMV) D+/R- patients, while any R+ patients were managed with a preemptive approach. In period 2, immunosuppression consisted of basiliximab or thymoglobulin induction, tacrolimus, steroids and mycophenolate. Three-month CMV prophylaxis with valganciclovir was used in all at-risk patients.
Data analysis included 73 patients (period 1) and 70 (period 2). Acute rejection was more frequent in period 1 than in period 2 (42% vs 7%, p <0.001). Overall, 30% of patients in period 1 were diagnosed with CMV infection/disease requiring antiviral treatment, compared with 11.4% in period 2 (p = 0.003). Late-onset CMV disease remained a problem in D+/R- patients in both periods. There was no difference in incidence of BK virus nephropathy, fungal infections, PTLD, graft loss or mortality. However, 4 cases (5.7%) of delayed transient asymptomatic agranulocytosis were observed in period 2.
The present analysis indicates that the combined regimen introduced in period 2 improved clinical results with a significant decrease in acute rejection and in CMV infection/disease incidence. However, a unique syndrome of delayed transient agranulocytosis probably due to drug myelotoxicity was observed in a subset of patients.
Keywords
Adult, Antibiotics, Antineoplastic/administration & dosage, Antibiotics, Antineoplastic/therapeutic use, Antiviral Agents/administration & dosage, Antiviral Agents/therapeutic use, Cytomegalovirus/drug effects, Drug Interactions, Drug Therapy, Combination, Female, Ganciclovir/administration & dosage, Ganciclovir/analogs & derivatives, Ganciclovir/therapeutic use, Humans, Immunosuppressive Agents/administration & dosage, Immunosuppressive Agents/therapeutic use, Kidney Transplantation, Male, Medical Audit, Middle Aged, Mycophenolic Acid/administration & dosage, Mycophenolic Acid/therapeutic use, Outcome Assessment, Health Care, Retrospective Studies, Safety, Switzerland, Tacrolimus/administration & dosage, Tacrolimus/therapeutic use, Valganciclovir
Pubmed
Web of science
Open Access
Yes
Create date
14/12/2017 11:46
Last modification date
10/10/2023 6:00
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