Terapia preemptiva de acordo com a percepção do risco de infecção por CMV após o transplante renal

• Ano de defesa: 2016
• Autor(a) principal: Pinto, Cahuê Henrique Motta Coli [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: targeted preemptive therapy according to perceived risk of cmv infection after kidney transplantation; Citomegalovírus; Transplante renal; Terapia preemptiva
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=4698436; http://repositorio.unifesp.br/handle/11600/47911

Background: The identification of the best strategy to manage CMV infection is hampered by uncertainties regarding the risk/benefit ratios of universal prophylaxis versus preemptive therapy, the impact of indirect CMV effects and the associated costs. This study investigated the efficacy and safety of targeted preemptive therapy according to perceived risk of CMV infection after kidney transplantation. Methods: 144 adult kidney transplant recipient were enrolled in this 12 month study. None received CMV pharmacological prophylaxis. Only high risk patients (D+/R-, use of induction therapy with antithymocyte globulin, treatment of rejection) received preemptive therapy using pp65 antigenemia test. When the low-risk patients had symptoms related to CMV , it was applied screening with pp65 antigenemia and treatment initiated if confirmed CMV disease. Blinded CMV DNAemia was collected weekly during the first 3 months. Results: The incidence of CMV infection was 34 % and CMV disease was 17 %. DNAemia was detected by week 3, was observed in 30% of patients who were not treated for CMV infection/disease, and ?2,384 copies/ml showed a sensitivity of 61% and specificity 85% to detect CMV disease (AUC=0.849±0.042, p<0.001). Using multivariable analysis, only antithymocyte globulin induction was associated with CMV infection/disease whereas only expanded donor criteria and renal function at 30 days were associated with renal function 12 months after transplantation. Conclusion: Targeted preemptive therapy in patients with perceived higher risk for CMV infection/disease was effective in preventing severe clinical presentation, including tissue invasive and late CMV infection. This strategy is associated with direct and indirect cost-savings.