Journal of Nephrology & Therapeutics

Considering Prophylaxis for Cytomegalovirus Disease in Cytomegalovirus Positive Renal Transplant Recipients from Positive Donors in a Resource Limited South African Public Hospital

Abstract

Paget G*,Naicker S

Giving cytomegalovirus (CMV) prophylaxis to CMV positive recipients is expensive in a resource-limited setting like South Africa. We report a retrospective analysis of CMV disease in 47 CMV donor/recipient positive (D+/R+) adult renal transplant patients (> 80% African Blacks) from February 2000 to November 2004 who had received four drug induction immune suppression. We commenced routine valganciclovir prophylaxis for 3 months post renal transplant in January 2007 and reviewed incidence of CMV disease from January 2007, in similar patients, until October 2009. Before prophylaxis, incidence of CMV disease was 32% in D+/R+ and was similar to recipient negative/donor positive (D-/R+) patients, however graft survival analysis adjusted for CMV disease showed that D+/R+ recipients had a hazard ratio of 2.8 (p=0.03) for poor graft outcome. After prophylaxis, among deceased donor recipients the incidence of CMV disease over a mean follow up of 17.3 months was 6% (n=2), and nil in live donor recipients. Our immunosuppressive therapy carries a risk of CMV disease in approximately a third of patients and is associated with poorer graft outcomes. CMV prophylaxis has been highly effective at reducing the incidence of CMV disease, and is important in a setting with ever decreasing availability of organs for transplantation.