Korean J Transplant.  2020 Mar;34(1):15-23. 10.4285/kjt.2020.34.1.15.

Effectiveness of valacyclovir prophylaxis against the occurrence of cytomegalovirus infection in kidney transplant recipients

Affiliations
  • 1Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
  • 2Keimyung University Kidney Institute, Daegu, Korea

Abstract

Background
Cytomegalovirus (CMV) infection is a crucial infection in kidney transplant recipients (KTRs) despite advancements in diagnostic and treatment methods. There are still many controversies about the ways to prevent CMV infection.
Methods
We retrospectively analyzed 153 KTRs who underwent kidney transplantation (KT) between September 2013 and January 2016. We classified KTRs into two groups: valacyclovir prophylaxis group (intravenous ganciclovir for 2 weeks after KT, followed by oral valacyclovir for 3 months) and historical control group (only intravenous ganciclovir for 2 weeks after KT). We evaluated the incidence of CMV infection, clinical outcomes, CMV-free survival rate between the two groups and risk factors for the development of CMV infection.
Results
Mean time between KT and diagnosis of CMV infection was 4.5±3.3 months. The valacyclovir prophylaxis group showed lower incidence of CMV infection than the historical control group (21.7% vs. 43.9%, P=0.011). The valacyclovir prophylaxis group showed higher CMV-free survival rate than the control group (P=0.011). In multivariable- adjusted analysis, independent risk factors for the development of CMV infection were no valacyclovir prophylaxis, older age at KT, thymoglobulin induction, and delayed graft function.
Conclusions
Valacyclovir prophylaxis for 3 months showed significant reduction in the incidence of CMV infection in KTRs. Therefore, we suggest valacyclovir prophylaxis for 3 months in KTRs with risk factors such as old age, thymoglobulin induction, and delayed graft function.

Keyword

Antibiotic prophylaxis; Antithymocyte serum; Cytomegalovirus infections; Kidney transplantation; Risk factors
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