RT Journal Article
T1 Immunoguided Discontinuation of Prophylaxis for Cytomegalovirus Disease in Kidney Transplant Recipients Treated With Antithymocyte Globulin: A Randomized Clinical Trial.
A1 Paez-Vega, Aurora
A1 Gutierrez-Gutierrez, Belen
A1 Agüera, Maria L
A1 Facundo, Carme
A1 Redondo-Pachon, Dolores
A1 Suñer, Marta
A1 Lopez-Oliva, Maria O
A1 Yuste, Jose R
A1 Montejo, Miguel
A1 Galeano-Alvarez, Cristina
A1 Ruiz-San Millan, Juan C
A1 Los-Arcos, Ibai
A1 Hernandez, Domingo
A1 Fernandez-Ruiz, Mario
A1 Muñoz, Patricia
A1 Valle-Arroyo, Jorge
A1 Cano, Angela
A1 Rodriguez-Benot, Alberto
A1 Crespo, Marta
A1 Rodelo-Haad, Cristian
A1 Lobo-Acosta, María A
A1 Garrido-Gracia, Jose C
A1 Vidal, Elisa
A1 Guirado, Luis
A1 Cantisan, Sara
A1 Torre-Cisneros, Julian
K1 CMV-specific cell-mediated immunity
K1 QuantiFERON-CMV assay
K1 Antithymocyte globulin
K1 Cytomegalovirus infection
K1 Kidney transplant
AB Antiviral prophylaxis is recommended in cytomegalovirus (CMV)-seropositive kidney transplant (KT) recipients receiving antithymocyte globulin (ATG) as induction. An alternative strategy of premature discontinuation of prophylaxis after CMV-specific cell-mediated immunity (CMV-CMI) recovery (immunoguided prevention) has not been studied. Our aim was to determine whether it is effective and safe to discontinue prophylaxis when CMV-CMI is detected and to continue with preemptive therapy. In this open-label, noninferiority clinical trial, patients were randomized 1:1 to follow an immunoguided strategy, receiving prophylaxis until CMV-CMI recovery or to receive fixed-duration prophylaxis until day 90. After prophylaxis, preemptive therapy (valganciclovir 900 mg twice daily) was indicated in both arms until month 6. The primary and secondary outcomes were incidence of CMV disease and replication, respectively, within the first 12 months. Desirability of outcome ranking (DOOR) assessed 2 deleterious events (CMV disease/replication and neutropenia). A total of 150 CMV-seropositive KT recipients were randomly assigned. There was no difference in the incidence of CMV disease (0% vs 2.7%; P = .149) and replication (17.1% vs 13.5%; log-rank test, P = .422) between both arms. Incidence of neutropenia was lower in the immunoguided arm (9.2% vs 37.8%; odds ratio, 6.0; P  Prophylaxis can be prematurely discontinued in CMV-seropositive KT patients receiving ATG when CMV-CMI is recovered since no significant increase in the incidence of CMV replication or disease is observed. 
PB Oxford University Press
YR 2022
FD 2022
LK http://hdl.handle.net/10668/19734
UL http://hdl.handle.net/10668/19734
LA en
NO Páez-Vega A, Gutiérrez-Gutiérrez B, Agüera ML, Facundo C, Redondo-Pachón D, Suñer M, et al. Immunoguided Discontinuation of Prophylaxis for Cytomegalovirus Disease in Kidney Transplant Recipients Treated With Antithymocyte Globulin: A Randomized Clinical Trial. Clin Infect Dis. 2022 Mar 9;74(5):757-765
DS RISalud
RD Apr 5, 2025