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Less renal allograft fibrosis with valganciclovir prophylaxis for cytomegalovirus compared to high-dose valacyclovir: a parallel group, open-label, randomized controlled trial
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Less renal allograft fibrosis with valganciclovir prophylaxis for cytomegalovirus compared to high-dose valacyclovir: a parallel group, open-label, randomized controlled trial
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Less renal allograft fibrosis with valganciclovir prophylaxis for cytomegalovirus compared to high-dose valacyclovir: a parallel group, open-label, randomized controlled trial
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Journal Article
Less renal allograft fibrosis with valganciclovir prophylaxis for cytomegalovirus compared to high-dose valacyclovir: a parallel group, open-label, randomized controlled trial
2018
Overview
Background
Cytomegalovirus (CMV) prophylaxis may prevent CMV indirect effects in renal transplant recipients. This study aimed to compare the efficacy of valganciclovir and valacyclovir prophylaxis for CMV after renal transplantation with the focus on chronic histologic damage within the graft.
Methods
From November 2007 through April 2012, adult renal transplant recipients were randomized, in an open-label, single-center study, at a 1:1 ratio to 3-month prophylaxis with valganciclovir (
n
= 60) or valacyclovir (
n
= 59). The primary endpoint was moderate-to-severe interstitial fibrosis and tubular atrophy assessed by protocol biopsy at 3 years evaluated by a single pathologist blinded to the study group. The analysis was conducted in an intention-to-treat population.
Results
Among the 101 patients who had a protocol biopsy specimen available, the risk of moderate-to-severe interstitial fibrosis and tubular atrophy was significantly lower in those treated with valganciclovir (22% versus 34%; adjusted odds ratio, 0.31; 95% confidence interval, 0.11–0.90;
P
= 0.032 by multivariate logistic regression). The incidence of CMV disease (9% versus 2%;
P
= 0.115) and CMV DNAemia (36% versus 42%;
P
= 0.361) were not different at 3 years.
Conclusions
Valganciclovir prophylaxis, as compared with valacyclovir, was associated with a reduced risk of moderate-to-severe interstitial fibrosis and tubular atrophy in patients after renal transplantation.
Trial registration
Australian New Zealand Clinical Trials Registry (
ACTRN12610000016033
). Registered on September 26, 2007
Publisher
BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
Subject
/ Antibiotic Prophylaxis - methods
/ Antiviral Agents - therapeutic use
/ Atrophy
/ Biopsy
/ Cytomegalovirus - drug effects
/ Cytomegalovirus Infections - epidemiology
/ Cytomegalovirus Infections - prevention & control
/ Diabetes
/ Disease
/ Dose-Response Relationship, Drug
/ Female
/ Fibrosis
/ Fibrosis - prevention & control
/ Graft Survival - drug effects
/ Humans
/ Kidney Diseases - epidemiology
/ Kidney Diseases - prevention & control
/ Kidney Transplantation - adverse effects
/ Kidney Transplantation - statistics & numerical data
/ Male
/ Medicine
/ Patients
/ Transplantation, Homologous - adverse effects
/ Valacyclovir - therapeutic use
