Switch to
| Predicate | Object |
|---|---|
| rdf:type | |
| lifeskim:mentions |
umls-concept:C0001367,
umls-concept:C0010825,
umls-concept:C0012634,
umls-concept:C0017649,
umls-concept:C0022671,
umls-concept:C0035647,
umls-concept:C0087111,
umls-concept:C0205195,
umls-concept:C0205225,
umls-concept:C0301630,
umls-concept:C0355642,
umls-concept:C0376387,
umls-concept:C0445202,
umls-concept:C0677582
|
| pubmed:issue |
4
|
| pubmed:dateCreated |
1993-5-20
|
| pubmed:abstractText |
CMV-seronegative recipients of kidneys from CMV-seropositive donors (D+/R+) are at highest risk for developing clinical CMV disease. Even with routine prophylactic use of low-dose acyclovir we had a CMV disease incidence of 26% (5/19) in these patients. Published studies using either acyclovir or CMV hyperimmune globulin (HIG) alone as prophylaxis have also shown clinical disease in 20-30% of D+/R+ patients--less than controls but still significantly greater than in comparable CMV+ recipients (R+). The purpose of this study was to determine whether the risk of primary CMV disease in D+/R- patients was reduced by prophylaxis with combined CMV-HIG and low-dose acyclovir as follows: CMV-HIG (Immuno) 1 ml/kg i.v. immediately prior to transplantation and at 3-week intervals for 6 months; acyclovir 600 mg/day p.o. for 3 months. A total of 361 consecutive renal transplants were studied prospectively. All D+/R- pts (n = 73) received CMV-HIG and acyclovir, the others (91 D+/R+, 74 D-/R+, 123 D-/R-) received only low-dose acyclovir. The incidence of clinical CMV disease, CMV-related graft loss, graft and patient survival, and the influence of ALG and OKT-3 were analyzed and compared between groups. Of the 361 patients only 18 (5%) developed CMV disease, with 5 CMV-related graft losses. CMV disease occurred in only 10% of the D+/R- patients, lower than in previously reported studies. Significantly the incidence was as low as in CMV+ recipients of kidneys from both CMV+ (6%) and CMV- (7%) donors. Use of OKT-3 for steroid-resistant rejection increased the risk of developing CMV disease: 11/50 (22%) receiving OKT-3 developed CMV disease vs. only 7/311 (2%) who did not (P < 0.001); 11/18 (61%) with CMV disease had received OKT-3. ALG induction immunosuppression did not increase the risk of CMV in patients who subsequently received OKT-3. No patient developed CMV disease after discontinuing prophylaxis. There were no complications related to either CMV-HIG or acyclovir use. Compared with all other patients, the D+/R- group had superior graft survival at 1 and 3 years (94% vs. 87% and 86% vs. 74%, P < 0.05) but similar patient survival. Combined CMV-HIG and low-dose acyclovir appear to be better than either agent alone in preventing primary CMV disease in CMV- patients who receive CMV+ kidneys. Low-dose oral acyclovir (600 mg/day) may be as effective in preventing CMV disease as higher-dose prophylactic regimens, at least when accompanied by CMV-HIG.(ABSTRACT TRUNCATED AT 400 WORDS)
|
| pubmed:language |
eng
|
| pubmed:journal | |
| pubmed:citationSubset |
IM
|
| pubmed:chemical | |
| pubmed:status |
MEDLINE
|
| pubmed:month |
Apr
|
| pubmed:issn |
0041-1337
|
| pubmed:author | |
| pubmed:issnType |
Print
|
| pubmed:volume |
55
|
| pubmed:owner |
NLM
|
| pubmed:authorsComplete |
Y
|
| pubmed:pagination |
841-6
|
| pubmed:dateRevised |
2009-10-8
|
| pubmed:meshHeading |
pubmed-meshheading:8386404-Acyclovir,
pubmed-meshheading:8386404-Adolescent,
pubmed-meshheading:8386404-Adult,
pubmed-meshheading:8386404-Aged,
pubmed-meshheading:8386404-Child,
pubmed-meshheading:8386404-Child, Preschool,
pubmed-meshheading:8386404-Cytomegalovirus,
pubmed-meshheading:8386404-Cytomegalovirus Infections,
pubmed-meshheading:8386404-Drug Therapy, Combination,
pubmed-meshheading:8386404-Graft Survival,
pubmed-meshheading:8386404-Humans,
pubmed-meshheading:8386404-Immunization, Passive,
pubmed-meshheading:8386404-Immunoglobulins,
pubmed-meshheading:8386404-Infant,
pubmed-meshheading:8386404-Infant, Newborn,
pubmed-meshheading:8386404-Kidney Transplantation,
pubmed-meshheading:8386404-Middle Aged,
pubmed-meshheading:8386404-Muromonab-CD3,
pubmed-meshheading:8386404-Tissue Donors
|
| pubmed:year |
1993
|
| pubmed:articleTitle |
Reduction by combination prophylactic therapy with CMV hyperimmune globulin and acyclovir of the risk of primary CMV disease in renal transplant recipients.
|
| pubmed:affiliation |
Kidney Transplant Service, Victoria General Hospital, Halifax, Nova Scotia, Canada.
|
| pubmed:publicationType |
Journal Article,
Comparative Study
|