KAMINSKI, Hanah; COUZI, Lionel; GARRIGUE, Isabelle; MOREAU, J-F; DECHANET-MERVILLE, Julie; MERVILLE, Pierre

doi:10.1111/ajt.13781

COUZI, Lionel
Microbiologie Fondamentale et Pathogénicité [MFP]

GARRIGUE, Isabelle

Microbiologie Fondamentale et Pathogénicité [MFP]

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Article de revue

Ce document a été publié dans

American Journal of Transplantation. 2016-08-01, vol. 16, n° 8, p. 2384-94

Résumé en anglais

Universal prophylaxis for cytomegalovirus (CMV) prevention is viable but, compared with a preemptive strategy, leads to higher incidence of late-onset disease (LOD) associated with poor patient and graft survival. The purpose of this study was to compare LOD with early onset disease (EOD), with a focus on the highest risk kidney transplant recipients (KTRs): CMV seronegative recipients transplanted from seropositive donors (D+R-). Since CMV control depends on both antiviral treatment and specific immune response, we also compared Vδ2-negative (Vδ2(neg) ) γδ T cell expansion involved in CMV infection resolution. EOD was defined as occurring 3 mo after transplantation. Depending on the period, universal prophylaxis or preemptive treatment was used. Overall, 168 D+R- KTRs were included between 2003 and 2011. LOD was associated with a lower peak DNAemia (p = 0.04), fewer recurrences (odds ratio 0.16; 95% confidence interval 0.05-0.55; p = 0.01) and shorter anti-CMV curative treatment (40 vs. 60 days, p < 0.0001). As a corollary, we found that Vδ2(neg) γδ T cell expansion was faster in LOD than in EOD (31 vs. 168 days after the beginning of CMV disease, p < 0.0001). In D+R- KTRs, universal prophylaxis is associated with more LOD, which had better infection management and a faster immune response. These results support the use of universal prophylaxis over a preemptive strategy and reappraise outcomes of LOD.< Réduire

Mots clés en anglais

Age of Onset

Antiviral Agents

Cytomegalovirus

Cytomegalovirus Infections

Female

Follow-Up Studies

Glomerular Filtration Rate

Graft Survival

Humans

Kidney Failure

Chronic

Kidney Function Tests

Kidney Transplantation

Male

Middle Aged

Prognosis

Retrospective Studies

Risk Factors

T-Lymphocytes

Tissue Donors

URI

https://oskar-bordeaux.fr/handle/20.500.12278/184831

DOI

http://dx.doi.org/10.1111/ajt.13781

Unités de recherche

MFP (Laboratoire Microbiologie Fondamentale et Pathogénicité) - UMR 5234

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Easier Control of Late-Onset Cytomegalovirus Disease Following Universal Prophylaxis Through an Early Antiviral Immune Response in Donor-Positive, Recipient-Negative Kidney Transplants.

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Résumé en anglais

Mots clés en anglais

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DOI

Unités de recherche