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Immune Monitoring-Guided Versus Fixed Duration of Antiviral Prophylaxis Against Cytomegalovirus in Solid-Organ Transplant Recipients: A Multicenter, Randomized Clinical Trial.
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- Author(s): Manuel, Oriol; Laager, Mirjam; Hirzel, Cédric; Neofytos, Dionysios; Walti, Laura N; Hoenger, Gideon; Binet, Isabelle; Schnyder, Aurelia; Stampf, Susanne; Koller, Michael; Mombelli, Matteo; Kim, Min Jeong; Hoffmann, Matthias; Koenig, Katrin; Hess, Christoph; Burgener, Anne-Valérie; Cippà, Pietro E; Hübel, Kerstin; Mueller, Thomas F; Sidler, Daniel
- Source:
Clinical Infectious Diseases; 2/15/2024, Vol. 78 Issue 2, p312-323, 12p- Subject Terms:
CYTOMEGALOVIRUS disease prevention; PREVENTION of surgical complications; RESEARCH; CONFIDENCE intervals; ANTIVIRAL agents; PATIENTS; KIDNEY transplantation; INDIVIDUALIZED medicine; PRE-exposure prophylaxis; TREATMENT effectiveness; RANDOMIZED controlled trials; COMPARATIVE studies; RESEARCH funding; DESCRIPTIVE statistics; T cells; STATISTICAL sampling; LIVER transplantation; TRANSPLANTATION of organs, tissues, etc. - Source:
- Additional Information
- Subject Terms:
- Abstract: Background The use of assays detecting cytomegalovirus (CMV)–specific T cell–mediated immunity may individualize the duration of antiviral prophylaxis after transplantation. Methods In this randomized trial, kidney and liver transplant recipients from 6 centers in Switzerland were enrolled if they were CMV-seronegative with seropositive donors or CMV-seropositive receiving antithymocyte globulins. Patients were randomized to a duration of antiviral prophylaxis based on immune monitoring (intervention) or a fixed duration (control). Patients in the control group were planned to receive 180 days (CMV-seronegative) or 90 days (CMV-seropositive) of valganciclovir. Patients were assessed monthly with a CMV ELISpot assay (T-Track CMV); prophylaxis in the intervention group was stopped if the assay was positive. The co-primary outcomes were the proportion of patients with clinically significant CMV infection and reduction in days of prophylaxis. Between-group differences were adjusted for CMV serostatus. Results Overall, 193 patients were randomized (92 in the immune-monitoring group and 101 in the control group), of whom 185 had evaluation of the primary outcome (87 and 98 patients). CMV infection occurred in 26 of 87 (adjusted percentage, 30.9%) in the immune-monitoring group and in 32 of 98 (adjusted percentage, 31.1%) in the control group (adjusted risk difference, −0.1; 95% confidence interval [CI], −13.0% to 12.7%; P =.064). The duration of prophylaxis was shorter in the immune-monitoring group (adjusted difference, −26.0 days; 95%, CI, −41.1 to −10.8 days; P <.001). Conclusions Immune monitoring resulted in a significant reduction of antiviral prophylaxis, but we were unable to establish noninferiority of this approach on the co-primary outcome of CMV infection. Clinical Trials Registration NCT02538172. [ABSTRACT FROM AUTHOR]
- Abstract: Copyright of Clinical Infectious Diseases is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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