Significant Increase in Cytomegalovirus (CMV) Infection in Solid Organ Transplants Associated With Increased Use of Thymoglobulin as Induction Therapy?

Abstract

BACKGROUND:

Cytomegalovirus (CMV) infection remains one of the most common viral pathogens affecting solid organ transplants (SOT). In 10 years of following the outcome of transplants, we noticed an increased incidence of CMV infection, along with increased use of rabbit anti-thymocyte globulin (rATG). The study aims to assess the incidence of active CMV infection and disease, response to treatment, and recurrence in a cohort of SOT. Furthermore, we look for correlating the CMV incidence with the type of induction therapy: r-ATG or interleukin 2 receptor-blocking antibody (basiliximab).

METHODS:

This was a single-center, retrospective 10-year study in patients submitted to kidney, kidney-liver, and kidney-pancreas transplants who used a preemptive therapy protocol for CMV.

RESULTS:

Among the 476 enrolled transplant recipients, 306 (64.2 %) had at least one episode of CMV infection (replication), and 71/306 patients (23.2 %) presented CMV-related disease. The most frequent clinical conditions associated with CMV disease were gastrointestinal. Among the 476 transplant patients, 333 received immunosuppressive induction with rATG (69.9 %); 140 (29.4 %) received induction with interleukin 2 receptor-blocking antibody (basiliximab). The initial maintenance immunosuppressive therapy in the patients who presented CMV infection was primarily performed with prednisone, tacrolimus, and sodium mycophenolate (91.7 %). The induction with rATG increased from 35.2%-94.6% in 10 years. The incidence of CMV infection was 20.7 % in the first year of observation and gradually increased to 87.3 % in the last year.

CONCLUSIONS:

The data suggest that the increase in the use of rATG in recent years could be responsible for the very expressive increase in the incidence of CMV infection/disease.

• Authors: Elen Almeida Romao, Aparecida Yulie Yamamoto, Gilberto Gambero Gaspar, Tania Marisa Pisi Garcia, Valmir Aparecido Muglia, Maria Estela Papini Nardin, Carlos Augusto Fernandes Molina, Viviane Cristina Teixeira Pedroso de Figueiredo, Miguel Moyses-Neto
• Journal: Transplantation proceedings (Transplant Proc) Vol. 55 Issue 9 Pg. 2035-2040 (Nov 2023) ISSN: 1873-2623 [Electronic] United States
• PMID: 37778934 (Publication Type: Journal Article)
• Copyright: Copyright © 2023 Elsevier Inc. All rights reserved.

Chemical References

• thymoglobulin
• Antilymphocyte Serum
• Basiliximab
• Immunosuppressive Agents
• Receptors, Interleukin-2

Topics

• Humans
• Antilymphocyte Serum (adverse effects)
• Cytomegalovirus
• Basiliximab (therapeutic use)
• Retrospective Studies
• Induction Chemotherapy
• Kidney Transplantation (adverse effects)
• Graft Rejection
• Immunosuppressive Agents (therapeutic use)
• Cytomegalovirus Infections (diagnosis, epidemiology, drug therapy)
• Organ Transplantation (adverse effects)
• Receptors, Interleukin-2