CMV viremia in transplant recipients receiving basiliximab or low-dose antithymocyte-globulin induction without valganciclovir prophylaxis

Background: CMV is a major cause of morbidity in transplant recipients and manifests as tissue invasive diseaseor CMV viral syndrome. Controversy exists regarding best method for CMV prevention.

AIM OF THE STUDY:

To evaluate incidence of CMV viremia and symptomatic CMV infection in adult KTR with basiliximab or antithymocyte globulin (ATG) induction without the use of valganciclovir prophylaxis.

METHODS:

A prospective; open-label; single centre study. Patients were monitored for CMV DNA-PCR twice a week for month 1 post-transplant; once a week in month2; and then every 2 weeks in month 3; and then once a month from month 4 to 6.Inclusion Criteria:First living related donor (LD) kidney transplant; age > 18yr Exclusion Criteria:second or more transplants; Hepatitis B or C infection; CMV D+/R- and Pregnancy. Induction therapy:ATG 1.5mg/kg:day 0 and 2Basiliximab 20 mg:day 0 and 4 Maintenance:Tac+MMF+steroids in standard doses.Asymptomatic CMV infections: PCR> 2000 copies/ml without organ dysfunctionSymptomatic CMV infection/disease: PCR> 2000 copies/ml with organ involvement Valganciclovir was started if CMV PCR > 2000 copies/mL in ≥ 2 consecutive samples.

RESULTS:

We included 40 patients with low-dose ATG induction (group1) and 20 patients with Basiliximab induction (group2) Mean recipient age was 40.95 and 45.9 yr in group 1 and 2; mean donor age was 49.53 and 51.6 yr resp. Male recipients were 67.5% and 65% in group 1 and 2 respectively; male donors were 22.5% and 20% respectively (not signficant). Average HLA mismatches were 4.1/6 and 3.7/6 (not sign). In group1 average transfusions per patient were 2.3 units (vs 1.7units in group 2) and 24.13% pts in group1 had >3 units transfusion. Mean follow-up was 26.1 and 32.7 months respectively.Incidence of acute rejection was 7.5% (3/40) and 10% (2/20) in group 1 and 2 respectively. (not significant). Incidence of CMV viremia requiring valganciclovir therapy was 1.25% (5/40) and 10% (2/20) in group 1 and 2 respectively. (not significant). No patient developed CMV disease.Mean serum creatinine was 1.12 and 1.09 mg/dL at 1 month and 1.2 and 1.14 mg/dL at 3 months (not sign).

CONCLUSIONS:

The incidence of CMV viremia is low and not significantly different in patients receiving basiliximab or low dose ATG induction in living donor KTR on tacrolimus based immunosuppression.Hence universal prophylaxis with valganciclovir may not be required with basiliximab and low dose ATG induction.