Persisting Gaps in Cytomegalovirus Prevention and Management After Solid Organ Transplantation in a Resource-Limited Setting.

IF 2.6 4区医学 Q3 IMMUNOLOGY Transplant Infectious Disease Pub Date : 2025-01-10 DOI:10.1111/tid.14440

Guilherme Santoro-Lopes, Luiz Felipe Abreu Guimarães, Wanessa Trindade Clemente, Raquel Silveira Bello Stucchi, Edson Abdala, Daniel Wagner de Castro Lima Santos, Gustavo Fernandes Ferreira, Luciana Bertocco Paiva Haddad, Ligia Camera Pierrotti

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引用次数: 0

Abstract

Background: Cytomegalovirus (CMV) infection remains among the leading complications after solid organ transplantation (SOT). Large international surveys mainly focused on high-income countries, detected considerable variability in the management of this infection after SOT. Limited data are available from resource-limited settings.

Methods: A questionnaire-based cross-sectional study was performed. All transplant programs (TP) registered at the Brazilian Organ Transplantation Society (ABTO) were invited to participate.

Results: Sixty-one TP participated in the study. Of these, 59 (97%) reported using at least 1 preventive strategy (prophylaxis or preemptive therapy [PET]). Prophylaxis was reported by only 39 (64%). PET was used by 52 (85%), predominantly for R+ recipients (n = 42/61; 70%). CMV monitoring was performed weekly in only 22 of 52 (42%) TP. This was significantly more common in TP reporting turnaround times ≤72 h for quantitative nuclear acid amplification tests (p < 0.001). Intravenous (IV) ganciclovir was the predominant drug chosen for prophylaxis (21/39 TP; 54%) and for PET (44/52 TP; 77%). Lack of regular access to valganciclovir was significantly associated with the choice of IV ganciclovir for prophylaxis and PET (p = 0.002 for both comparisons). Only 8 (13%) TP had access to molecular diagnostic tests for ganciclovir resistance, and 14 (23%) had access to effective therapy for highly resistant infections.

Conclusion: These results suggest that strategies to improve the management of CMV after SOT in such a resource-limited setting are needed and should include not only targeted educational programs but also initiatives to tackle economic and structural barriers.

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来源期刊

Transplant Infectious Disease 医学-传染病学

CiteScore

5.30

自引率

7.70%

发文量

210

审稿时长

4-8 weeks

期刊介绍： Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.