Prophylaxis followed by preemptive approach versus prophylaxis to prevent CMV infection in CMV-seropositive kidney transplant recipients receiving anti-thymocyte globulin induction therapy
Issued Date
2025-11-01
Resource Type
eISSN
18783511
Scopus ID
2-s2.0-105020092816
Pubmed ID
40987395
Journal Title
International Journal of Infectious Diseases IJID Official Publication of the International Society for Infectious Diseases
Volume
160
Rights Holder(s)
SCOPUS
Bibliographic Citation
International Journal of Infectious Diseases IJID Official Publication of the International Society for Infectious Diseases Vol.160 (2025) , 108073
Suggested Citation
Rattnaruangsup T., Kitpermkiat R., Bruminhent J. Prophylaxis followed by preemptive approach versus prophylaxis to prevent CMV infection in CMV-seropositive kidney transplant recipients receiving anti-thymocyte globulin induction therapy. International Journal of Infectious Diseases IJID Official Publication of the International Society for Infectious Diseases Vol.160 (2025) , 108073. doi:10.1016/j.ijid.2025.108073 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/112920
Title
Prophylaxis followed by preemptive approach versus prophylaxis to prevent CMV infection in CMV-seropositive kidney transplant recipients receiving anti-thymocyte globulin induction therapy
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Author's Affiliation
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Abstract
BACKGROUND: CMV infection is a major complication in CMV-seropositive kidney transplant recipients receiving ATG induction. This study compared CMV infection rates between hybrid (prophylaxis plus preemptive) and universal prophylaxis strategies in this high-risk group. METHODS: We retrospectively studied CMV-seropositive KT recipients receiving ATG (2018-2024), comparing a hybrid strategy (IV ganciclovir plus CMV DNA monitoring) with universal prophylaxis (3-month oral valganciclovir). Outcomes included CMV infection, clinically significant CMV infection (CsCMVi), and adverse events. Risk factors for CsCMVi were analyzed using multivariate Cox regression. RESULTS: A total of 111 CMV-seropositive KT recipients were included (75 hybrid, 36 prophylaxis). CMV infection was significantly more frequent in the hybrid group (70.7% vs. 16.7%, P < 0.001), as was CsCMVi (33.3% vs. 5.6%, P = 0.001) and allograft dysfunction (45.3% vs. 16.7%, P = 0.01). Hematologic toxicities (neutropenia, leukopenia, lymphopenia) were comparable (all p=NS). In multivariate analysis, independent risk factors for CsCMVi included the hybrid strategy (HR 6.06; 95% CI,1.04-35.36; P = 0.045), higher panel-reactive antibody (HR 1.02; 95% CI,1.00-1.04; P = 0.019), and >40% decline in eGFR at discharge (HR 48.09; 95% CI,4.39-527.20; P = 0.002). Hypertension was protective (HR 0.12; 95% CI,0.04-0.80; P = 0.024). CONCLUSION: In CMV-seropositive recipients receiving lymphocyte-depleting induction, a hybrid strategy of initial prophylaxis followed by preemptive therapy was associated with inferior outcomes compared to universal prophylaxis.