Renal transplant alıcılarında düşük doz valgansiklovir profilaksisinin etkinliği ve güvenilirliği

Amaç: Sitomegalovirüs (CMV) infeksiyonu, böbrek nakli sonrasında en sık görülen infeksiyonlardan biridir. Sitomegalovirüs (Immunglogulin G) -seropozitif donör ve CMV-seropozitif alıcı ( D+/A+) arasında yapılan nakiller orta riskli kabul edilmektedir. Çalışmamızda renal transplantasyon yapılmış hastalarda nakil sonrası 1 yıllık dönem için düşük doz (450 mg/g) valgansiklovirin CMV kemoprofilaksindeki etkinliğini araştırdık.Gereç ve Yöntem: Ocak 2016 ile Haziran 2019 tarihleri arasında böbrek nakli yapılmış 18 yaş üzerinde ardışık 68 hasta retrospektif olarak çalışmaya dahil edildi. Tüm hastalara 100 gün süreyle 450 mg/g valgansiklovir tedavisi verildi. Düşük doz valgansiklovirin etkinliği hastaların posttransplant 1 yıl içerisinde CMV hastalığı geçirip geçirmemeleri dikkate alınarak belirlendi.Bulgular: Sadece bir hastada (n=1/68) (%1,5) CMV hastalığı gelişti. Nakil sonrası 134. günde nedeni açıklanamayan GFR kaybı olan hastanın CMV DNA titresi pozitif geldi. Tüm grupta CMV hastalığı ilişkili akut rejeksiyon, graft kaybı, lökopeni, PTDM, fırsatçı infeksiyon veya hasta kaybı gelişmedi.Sonuç: Literatürde transplant hastalarında CMV profilaksisi için düşük doz (450 mg/g) valgansiklovir tedavisinin standart doz (900 mg/g) ile karşılaştıran çok sayıda araştırma mevcuttur. Çalışmamızda düşük doz valgansiklovirin D+/A+ orta riskli hastalarda CMV hastalığının profilaksisi için yeterli olduğu ve yan etkiye yol açmadığını gördük. Bu konu ile ilgili geniş hasta katılımlı klinik çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

renal transplantasyon, sitomegalovirüs, valgansiklovir

Efficacy and safety of low-dose valganciclovir prophylaxis among renal transplant recipients

Purpose: Cytomegalovirus (CMV) infection is one of the most common infections observed following kidney transplantations. Transplantations between cytomegalovirus (Immunoglobulin G)-seropositive donor and CMV-seropositive recipient (D+/R+) are considered to be of moderate risk. In our study, we investigated the efficacy of low-dose (450 mg/g) valganciclovir in CMV chemoprophylaxis in renal transplant patients over their first post-transplant year.Materials and Methods: A total of 68 consecutive patients aged over 18 years who underwent renal transplantation between January 2016 and June 2019 were included in this retrospective study. All patients were administered valganciclovir 450 mg/g, for 100 days. The efficacy of low-dose valganciclovir was determined by whether the patients developed a CMV disease during their first post-transplant year.Results: Only one patient (n=1/68) (1.5%) developed CMV disease. CMV DNA titer was positive on post-transplant day 134 of the patient who had unexplained loss of GFR. CMV disease-related acute rejection, graft loss, leukopenia, post-transplant diabetes mellitus, opportunistic infection, or patient loss was not observed.Conclusion: There are many studies comparing CMV prophylaxis with low and standard dose (450 vs. 900 mg/g) valganciclovir treatment in transplant patients. The results of this study show that low-dose valganciclovir is sufficient for the prophylaxis of CMV disease in D+/R+ medium-risk patients without leading to any side effects. Further clinical studies with larger patient participation are needed.

Keywords:

renal transplantation, cytomegalovirus, valganciclovir,

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