Among CMV-positive renal transplant patients receiving non-T-cell depleting induction, the absence of CMV disease prevention is a safe strategy: a retrospective cohort of 372 patients

Hugoline Boulay (1, 2) , Emmanuel Oger (1) , Diego Cantarovich (3) , Philippe Gatault (4) , Antoine Thierry (5) , Yannick Le Meur (6) , Agnès Duveau (7) , Cécile Vigneau (1) , Nolwenn Lorcy (6)

1 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
2 Irset - Institut de recherche en santé, environnement et travail
3 ITUN - Institut de transplantation urologie-néphrologie
4 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
5 Service de néphrologie - hémodialyse et transplantation rénale
6 CHU - BREST - Hôpital de la Cavale Blanche - CHRU Brest
7 CHU Angers - Centre Hospitalier Universitaire d'Angers

Cytomegalovirus (CMV) is the most common opportunistic pathogen affecting renal transplant recipients, especially in the first months. CMV-seropositive renal transplant recipients (CMV R+) are at intermediate risk for CMV disease, but this risk is enhanced among CMV R+ receiving T-cell depleting induction, compared to CMV R+ receiving non-depleting induction. In this second group, data in favour of prophylactic antiviral treatment with valganciclovir to reduce CMV disease is sparse. In this retrospective and multicentric trial, we included 372 CMV R+ transplanted between January 2012 and April 2015 and receiving non-depleting induction. During the first year following transplantation, CMV disease occurred in 5/222 patients (2.25%) in the prophylaxis group and 9/150 (6%) in the no-prophylaxis group (difference + 3.7; 95%CI - 0.5 to 8; p=0.002 for non-inferiority). The incidence of allograft rejection and other infectious diseases was similar between the 2 groups. Graft and patient survival were similar at the end of follow-up. In conclusion, the absence of prophylaxis did not appear to have a deleterious effect for CMV diseases among CMV R+ receiving non-depleting induction.

Mots clés: CMV disease prevention; kidney transplantation; valganciclovir

Domaines: Sciences du Vivant [q-bio]; Maladies infectieuses

Hugoline Boulay, Emmanuel Oger, Diego Cantarovich, Philippe Gatault, Antoine Thierry, et al.. Among CMV-positive renal transplant patients receiving non-T-cell depleting induction, the absence of CMV disease prevention is a safe strategy: a retrospective cohort of 372 patients. Transplant Infectious Disease, 2021, 23 (3), pp.e13541. ⟨10.1111/tid.13541⟩. ⟨hal-03095269⟩