Cytomegalovirus in Renal Transplant Recipients from Living Donors with and without Valgancyclovir Prophylaxis and with Immunosuppression Based in Anti-thymocyte globulin or Basiliximab

Background In our population, anti-thymocyte globulin (ATG) of 1 mg/Kg/day for 4 days is used; which permits not using valgancyclovir (VGC) prophylaxis in some renal transplant recipients (RTR) of moderate risk (R+), to reduce costs. Our objective was to determine the incidence and risk for the development of cytomegalovirus (CMV) with or without prophylaxis, when exposed to low doses of ATG or basiliximab (BSL). Patients and methods A retrospective cohort included 265 RTRs with follow up of 12 months. Prophylaxis was used in R-/D + and only some R + . Tacrolimus (TAC), mycophenolate mofetil (MMF), and prednisone (PDN) were used in all patients. Logistic regression analysis was performed to estimate the risk of CMV in RTR with or without VGC. Results Cytomegalovirus was documented in 46 (17.3%) patients: twenty (43.5%) with CMV infection, and 26 (56.5%) with CMV disease. Anti-thymocyte globulin was used in 39 (85%): 32 "R+", 6 "D+/R-," and 1 "D-/R-". In 90% (27/30) of patients with CMV and without prophylaxis, ATG was used. The multivariate analysis showed an association of risk for CMV with the absence of prophylaxis (RR 2.29; CI 95%, 1,08-4.86), ATG use (RR 3.7; CI 95%, 1.50-9.13), TAC toxicity (RR 3,77; CI 95%, 1,41 -10,13), and lymphocytes at the sixth post-transplant month (RR 1,77; CI 95%, 1,0-3.16). Conclusions Low doses of ATG favor the development of CMV and a lower survival free of CMV compared with BSL. In scenarios where resources for employing VGC are limited, one acceptable strategy could be the use of BSL.