An international survey of cytomegalovirus prevention and treatment practices in intestinal transplantation

Diana F Florescu, Kareem Abu-Elmagd, David F Mercer, Fang Qiu, Andre C Kalil

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Practice variation regarding cytomegalovirus (CMV) prevention and treatment across intestinal transplantation (IT) programs is unknown. Methods: An electronic survey was sent to IT programs registered with the Intestinal Transplant Association. Proportions were analyzed for categorical variables; means and SDs were analyzed for continuous variables. Results: Seventy-seven percent of IT programs responded to the survey. For CMV D+/R-recipients, 39.1% programs used universal prophylaxis (UP), 8.7% preemptive strategy (PE), and 52.2% hybrid strategy. For CMV R+ recipients, 45.8% programs used UP, 12.5% PE, 37.1% hybrid strategy, and 4.2% none. For CMV D-/R-recipients, 39.1% programs used UP, 21.7% PE, 26.1% hybrid strategy, and 13% none. Frequency of monitoring for PE was weekly 71.4% of programs, every 2 weeks 21.4%, and monthly 7.1%. For CMV viremia, syndrome and disease, the most common first-line agents used were ganciclovir (100% and 96.2%) and valganciclovir (23.1%) and the second-line agent was foscarnet (73.1% and 84.6%). Immunoglobulins were administered in 65.4% of the programs for pneumonia (69.2%), meningoencephalitis (50%), enteritis (46.2%), colitis (38.5%), syndrome (42.3%), viremia (30.8%), and resistant/refractory infections (11.5%). Conclusions: Prophylaxis and hybrid strategy were the most commonly used. Treatment practices were consistent and mainly involved ganciclovir as first-line agent and foscarnet as second-line agent. The use of immunoglobulins appeared to be more common than in other allografts.

Original languageEnglish (US)
Pages (from-to)78-82
Number of pages5
JournalTransplantation
Volume97
Issue number1
DOIs
StatePublished - Jan 15 2014

Fingerprint

Cytomegalovirus
Transplantation
Foscarnet
Ganciclovir
Viremia
Immunoglobulins
Therapeutics
Meningoencephalitis
Enteritis
Colitis
Allografts
Pneumonia
Surveys and Questionnaires
Transplants
Infection

Keywords

  • Cytomegalovirus (CMV)
  • Intestinal
  • Preemptive
  • Prophylaxis
  • Small bowel
  • Transplant
  • Treatment

ASJC Scopus subject areas

  • Transplantation

Cite this

An international survey of cytomegalovirus prevention and treatment practices in intestinal transplantation. / Florescu, Diana F; Abu-Elmagd, Kareem; Mercer, David F; Qiu, Fang; Kalil, Andre C.

In: Transplantation, Vol. 97, No. 1, 15.01.2014, p. 78-82.

Research output: Contribution to journalArticle

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abstract = "Background: Practice variation regarding cytomegalovirus (CMV) prevention and treatment across intestinal transplantation (IT) programs is unknown. Methods: An electronic survey was sent to IT programs registered with the Intestinal Transplant Association. Proportions were analyzed for categorical variables; means and SDs were analyzed for continuous variables. Results: Seventy-seven percent of IT programs responded to the survey. For CMV D+/R-recipients, 39.1{\%} programs used universal prophylaxis (UP), 8.7{\%} preemptive strategy (PE), and 52.2{\%} hybrid strategy. For CMV R+ recipients, 45.8{\%} programs used UP, 12.5{\%} PE, 37.1{\%} hybrid strategy, and 4.2{\%} none. For CMV D-/R-recipients, 39.1{\%} programs used UP, 21.7{\%} PE, 26.1{\%} hybrid strategy, and 13{\%} none. Frequency of monitoring for PE was weekly 71.4{\%} of programs, every 2 weeks 21.4{\%}, and monthly 7.1{\%}. For CMV viremia, syndrome and disease, the most common first-line agents used were ganciclovir (100{\%} and 96.2{\%}) and valganciclovir (23.1{\%}) and the second-line agent was foscarnet (73.1{\%} and 84.6{\%}). Immunoglobulins were administered in 65.4{\%} of the programs for pneumonia (69.2{\%}), meningoencephalitis (50{\%}), enteritis (46.2{\%}), colitis (38.5{\%}), syndrome (42.3{\%}), viremia (30.8{\%}), and resistant/refractory infections (11.5{\%}). Conclusions: Prophylaxis and hybrid strategy were the most commonly used. Treatment practices were consistent and mainly involved ganciclovir as first-line agent and foscarnet as second-line agent. The use of immunoglobulins appeared to be more common than in other allografts.",
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