Fighting Infections After Transplant

Kidney transplant recipients may benefit from waiting to treat cytomegalovirus infection

(RxWiki News) Kidney transplant patients are at risk of infection, mainly because of the drugs they take after surgery. These patients often get treatment to prevent infection before the symptoms set in.

Waiting to treat the most common infection in transplant patients may be better than trying to prevent infection, according to recent research.

"Learn the risks of transplant before surgery."

After kidney transplant surgery, patients commonly take drugs that slow down the immune system so that their body does not reject the new organ.

Unfortunately, these drugs may also increase the chances of infection, especially cytomegalovirus infection.

Tomas Reischig, MD, PhD, of Charles University Medical School and Teaching Hospital in the Czech Republic, and colleagues wanted to see if it was better to treat cytomegalovirus infection before or after signs of the virus appeared.

The researchers compared the two main strategies for fighting cytomegalovirus infection: universal antiviral prophylaxis and pre-emptive therapy. Universal prophylaxis involves giving drugs to all at-risk patients for several months after surgery.

Patients on pre-emptive therapy are watched closely with lab tests for signs of the virus. Pre-emptive therapy patients are given drugs only when their viral counts are high and only for a short period of time.

Dr. Reischig and colleagues found that 6 percent of patients on pre-emptive therapy developed infection, compared to 9 percent of those receiving prophylaxis.

Patients on prophylactic treatment were 2.5 times more likely to have serious kidney scarring and atrophy (when kidneys shrink in size) than patients on pre-emptive therapy.

Even though rates of infection were similar for both groups, the kidneys of patients on pre-emptive therapy were more likely to survive after 4 years.

More specifically, the 4-year kidney survival rate was 92 percent in the pre-emptive therapy group and 74 percent in the prophylaxis group.

These findings suggest that pre-emptive therapy may lead to less kidney complications and better survival of kidney transplants.

According to Dr. Reischig, the researchers expected that prophylaxis would lower the risk of kidney rejection. However, they found that the opposite was true.

The study included 55 kidney transplant patients.

The research was published August 23 in the Journal of the American Society of Nephrology.

Review Date: 
August 28, 2012