Medical Research: What is the background for this study? What are the main findings?
Dr. Erdbruegger: Controversy exists whether CMV infections or viremia after kidney transplantation affect patient and graft survival.
We aimed to explore the role of CMV in a retrospective study on almost 600 patients followed at our transplant center over a period of up to 10 years post-transplant. The analysis included protocol biopsy findings and causes for graft failure and death.
We observed reduced patient and graft survival in patients with CMV as reported in some of the previous studies. However, we found that patients with CMV had an inferior kidney function and significant chronic allograft changes in the biopsies very early after transplantation – even before the CMV infection. Also, CMV infection was not specifically related to a progression of chronic changes. On the other hand, we confirmed well-established factors like inferior graft function early on, delayed graft function, and higher donor and recipient age as important for patient and graft survival. In none of these analyses, CMV was a significant factor. In summary, this suggests that CMV is rather an epiphenomenon. Alternatively, we might have missed a possible small effect of CMV in our statistics. In any case, our results do not support a significant role of CMV in patient and graft outcomes.
Medical Research: What should clinicians and patients take away from your report?
Dr. Erdbruegger: There is an ongoing debate on the antiviral prophylaxis after kidney transplantation, based on the alleged role of CMV for patient and graft survival. In particular, should CMV prophylaxis be reserved for patients at high risk for CMV or should lower-risk patients get antiviral prophylaxis as well, and how long should antiviral prophylaxis be given?
We could not address this issue because our study was not a randomized therapy trial. Yet, absence of a significant role of CMV for patient and graft survival was observed in a setting where prophylaxis was given only to patients with high risk for CMV (i.e. CMV negative patients with a CMV positive organ) for three months. Therefore, our results do not suggest that extending the prophylaxis is an important factor for patient and graft survival. Though we do not suggest that some individual patients with low-risk CMV constellations should not receive prophylaxis, in particular if they had been treated more intensively for rejection.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Erdbruegger: A prospective randomized trial could help to determine the optimal antiviral prophylaxis for different risk groups of patients. This should be done with a sufficient length of follow-up to assess properly patient and allograft survival. Given the costs and potential side effects of antiviral treatment, a cost-benefit analysis should be included in such trial.
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Dr. Wilfried Gwinner and Dr. Uta Erdbruegger (2015). Study Does Not Support Significant Role of CMV Virus In Transplant Outcomes