Korean J Intern Med.  2019 Mar;34(2):375-382. 10.3904/kjim.2017.040.

Usefulness of valacyclovir prophylaxis for cytomegalovirus infection after anti-thymocyte globulin as rejection therapy

• Ko EJ
• Yu JH
• Yang CW
• Chung BH

• KMID: 2441017
• DOI: http://doi.org/10.3904/kjim.2017.040

Abstract

BACKGROUND/AIMS
Anti-thymocyte globulin (ATG) treatment for acute T-cell mediated rejection (TCMR) can increase the risk of cytomegalovirus (CMV) infection. We aimed to evaluate the effect of valacyclovir prophylaxis against CMV infection after ATG administration as anti-rejection therapy.
METHODS
We retrospectively analyzed 55 kidney transplant recipients (KTRs) receiving ATG for steroid resistant TCMR. In all KTRs, we used intravenous ganciclovir during ATG injection. In 34 KTRs treated before July 2013, we performed preemptive therapy for CMV infection after ATG therapy. They were regarded as the historic control group (CONT). After July 2013, we used valacyclovir maintenance for 1 month after ATG therapy in 21 patients (VAL). The primary outcome was the incidence of CMV infection, and the secondary outcomes were subsequent acute rejection, and graft and patient outcome.
RESULTS
Valacyclovir prophylaxis significantly reduced the incidence of CMV infection (VAL, 9.6% vs. CONT, 67.6%; p < 0.001), and CMV-free survival rate was higher in the VAL group compared to the CONT group (p = 0.009). In the VAL group, two cases of CMV infection were limited to CMV viremia, but CMV disease or syndrome (n = 3) was detected in the CONT group. There was no difference in graft failure (CONT, 70.5% vs. VAL, 47.6%; p = 0.152), incidence of subsequent rejection after ATG treatment (CONT, 41.1% vs. VAL, 33.3%; p = 0.776), and graft or patient survival between the two groups. There were no major adverse events associated with valacyclovir prophylaxis.
CONCLUSIONS
In conclusion, valacyclovir prophylaxis is effective in the prevention of CMV infection after ATG treatment for steroid resistant TCMR.

Keyword

Valacyclovir; Cytomegalovirus prophylaxis; Antilymphocyte serum; Rejection therapy; Kidney transplantation

MeSH Terms

Antilymphocyte Serum*
Cytomegalovirus Infections*
Cytomegalovirus*
Ganciclovir
Humans
Immunosuppression
Incidence
Kidney
Kidney Transplantation
Retrospective Studies
Survival Rate
T-Lymphocytes
Transplant Recipients
Transplants
Viremia
Antilymphocyte Serum
Ganciclovir