Control of cytomegalovirus-associated morbidity in renal transplant patients using intensive monitoring and either preemptive or deferred therapy

Daniel Brennan, Kathy A. Garlock, Bruce A. Lippmann, Richard S. Buller, Monique Gaudreault-Keener, Jeffrey A. Lowell, Steven B. Miller, Surendra Shenoy, Todd K. Howard, Gregory A. Storch

Research output: Contribution to journalArticle

Abstract

The objective of this randomized, prospective study was to compare preemptive to deferred treatment of cytomegalovirns (CMV) infection in high-risk renal transplant recipients. Conducted at a university-affiliated transplant center, the study included 36 renal allograft recipients with donor or recipient CMV-seropositivity who received anti-thymocyte induction therapy. Ganciclovir was administered intravenously for 21 days upon detection of CMV viremia (preemptive, N = 15) or detection of CMV viremia detection of associated with a CMV syndrome (deferted, N = 21). Shell vial culture, conventional culture, and polymerase chain reaction (PCR) were performed upon buffy-coat specimens weekly for 12 to 16 wk. CMV and non-CMV-associated charges were calculated. The comparative sensitivities of PCR, shell vial culture, and conventional culture were 91%, 44%, and 47%, respectively. A delay in specimen processing of > 24 h severely compromised the sensitivity of culture techniques but not that of PCR. Preemptive therapy tended to decrease symptomatic CMV episodes (0.4 versus 0.6 episodes per patient randomized; P = 0.22). One patient in each group had organ involvement, and no patient died. Allograft function and survival were similar. Ganciclovir use was increased in the preemptive group (1.2 versus 0.6 courses per patient randomized; P = 0.02). CMV-associated charges were $ 10,368 (preemptive) versus $ 5,752 (deferred); P = 0.13. PCR is superior to conventional monitoring to detect CMV viremia. Culture cannot be considered the 'gold standard' for detection of CMV viremia, especially when transport of specimens over distances results in processing delays. Preemptive therapy may reduce symptomatic CMV infections in renal transplant recipients. It was associated with higher CMV related charges but equivalent overall charges versus deferred treatment with intensive monitoring. Either strategy can achieve control of CMV infection after renal transplantation.

Original languageEnglish (US)
Pages (from-to)118-125
Number of pages8
JournalJournal of the American Society of Nephrology
Volume8
Issue number1
StatePublished - Jan 1 1997
Externally publishedYes

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Cytomegalovirus
Viremia
Morbidity
Transplants
Kidney
Polymerase Chain Reaction
Ganciclovir
Allografts
Therapeutics
Culture Techniques
Thymocytes
Infection Control
Infection
Kidney Transplantation
Tissue Donors
Prospective Studies
Survival
Transplant Recipients

ASJC Scopus subject areas

  • Nephrology

Cite this

Control of cytomegalovirus-associated morbidity in renal transplant patients using intensive monitoring and either preemptive or deferred therapy. / Brennan, Daniel; Garlock, Kathy A.; Lippmann, Bruce A.; Buller, Richard S.; Gaudreault-Keener, Monique; Lowell, Jeffrey A.; Miller, Steven B.; Shenoy, Surendra; Howard, Todd K.; Storch, Gregory A.

In: Journal of the American Society of Nephrology, Vol. 8, No. 1, 01.01.1997, p. 118-125.

Research output: Contribution to journalArticle

Brennan, D, Garlock, KA, Lippmann, BA, Buller, RS, Gaudreault-Keener, M, Lowell, JA, Miller, SB, Shenoy, S, Howard, TK & Storch, GA 1997, 'Control of cytomegalovirus-associated morbidity in renal transplant patients using intensive monitoring and either preemptive or deferred therapy', Journal of the American Society of Nephrology, vol. 8, no. 1, pp. 118-125.
Brennan, Daniel ; Garlock, Kathy A. ; Lippmann, Bruce A. ; Buller, Richard S. ; Gaudreault-Keener, Monique ; Lowell, Jeffrey A. ; Miller, Steven B. ; Shenoy, Surendra ; Howard, Todd K. ; Storch, Gregory A. / Control of cytomegalovirus-associated morbidity in renal transplant patients using intensive monitoring and either preemptive or deferred therapy. In: Journal of the American Society of Nephrology. 1997 ; Vol. 8, No. 1. pp. 118-125.
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abstract = "The objective of this randomized, prospective study was to compare preemptive to deferred treatment of cytomegalovirns (CMV) infection in high-risk renal transplant recipients. Conducted at a university-affiliated transplant center, the study included 36 renal allograft recipients with donor or recipient CMV-seropositivity who received anti-thymocyte induction therapy. Ganciclovir was administered intravenously for 21 days upon detection of CMV viremia (preemptive, N = 15) or detection of CMV viremia detection of associated with a CMV syndrome (deferted, N = 21). Shell vial culture, conventional culture, and polymerase chain reaction (PCR) were performed upon buffy-coat specimens weekly for 12 to 16 wk. CMV and non-CMV-associated charges were calculated. The comparative sensitivities of PCR, shell vial culture, and conventional culture were 91{\%}, 44{\%}, and 47{\%}, respectively. A delay in specimen processing of > 24 h severely compromised the sensitivity of culture techniques but not that of PCR. Preemptive therapy tended to decrease symptomatic CMV episodes (0.4 versus 0.6 episodes per patient randomized; P = 0.22). One patient in each group had organ involvement, and no patient died. Allograft function and survival were similar. Ganciclovir use was increased in the preemptive group (1.2 versus 0.6 courses per patient randomized; P = 0.02). CMV-associated charges were $ 10,368 (preemptive) versus $ 5,752 (deferred); P = 0.13. PCR is superior to conventional monitoring to detect CMV viremia. Culture cannot be considered the 'gold standard' for detection of CMV viremia, especially when transport of specimens over distances results in processing delays. Preemptive therapy may reduce symptomatic CMV infections in renal transplant recipients. It was associated with higher CMV related charges but equivalent overall charges versus deferred treatment with intensive monitoring. Either strategy can achieve control of CMV infection after renal transplantation.",
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