{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T03:22:25Z","timestamp":1778642545200,"version":"3.51.4"},"reference-count":25,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,10,22]],"date-time":"2020-10-22T00:00:00Z","timestamp":1603324800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Cytomegalovirus (CMV) remains an important challenge after kidney transplantation. Current Transplantation Society International Consensus Guidelines recommend antiviral prophylaxis or pre\u2010emptive therapy for high\u2010risk CMV\u2010seronegative recipients with a CMV\u2010seropositive donor (D+\/R\u2212) and moderate\u2010risk CMV\u2010seropositive recipients (R+). However, a split strategy according to CMV serostatus is not specifically mentioned.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We evaluated a split strategy to prevent CMV infection after kidney transplantation in which D+\/R\u2212 patients received valganciclovir (VGC) prophylaxis for 200\u00a0days, and R\u00a0+\u00a0patients were treated pre\u2010emptively according to CMV DNAemia. Patients were followed until 1\u2010year post\u2010transplant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between April 2014 and March 2018, 40 D+\/R\u2212 and 92 R\u00a0+\u00a0patients underwent kidney transplantation. Forty\u2010six percent received antithymocyte globulin (ATG) induction, and 98% was treated with calcineurin inhibitors, mycophenolic acid (MPA), and steroids. No D+\/R\u2212 patient developed CMV disease during prophylaxis (median 200\u00a0days), but 15% developed post\u2010prophylaxis or late\u2010onset disease. Fifty\u2010three percent developed neutropenia during prophylaxis, including 16\/40 (40%) grade 3 or 4 neutropenia requiring reduction\/discontinuation of MPA (30%) and\/or VGC (35%), and an occasional need for granulocyte colony\u2010stimulating factor (5%). In the R\u00a0+\u00a0group, 40% received antiviral therapy for a median duration of 21\u00a0days; 5% developed early\u2010onset CMV disease. Only 5% developed neutropenia. D+\/R\u00a0+\u00a0status (hazard ratio (HR) 2.09,<jats:italic>P\u00a0=\u00a0<\/jats:italic>.004) and ATG use (HR 2.81, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.0001) were risk factors for CMV reactivation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Prophylaxis leads to acceptable CMV control in high\u2010risk patients but comes with a high risk of neutropenia. Pre\u2010emptive therapy is effective and limits drug exposure in those at lower risk of CMV.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tid.13467","type":"journal-article","created":{"date-parts":[[2020,9,16]],"date-time":"2020-09-16T20:35:29Z","timestamp":1600288529000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["A split strategy to prevent cytomegalovirus after kidney transplantation using prophylaxis in serological high\u2010risk patients and a pre\u2010emptive strategy in intermediate\u2010risk patients: Combining the best of two options?"],"prefix":"10.1111","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8658-8735","authenticated-orcid":false,"given":"Rachel","family":"Hellemans","sequence":"first","affiliation":[{"name":"Department of Nephrology Antwerp University Hospital Edegem Belgium"},{"name":"Laboratory of Experimental Medicine and Pediatrics University of Antwerp Antwerpen Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veerle","family":"Wijtvliet","sequence":"additional","affiliation":[{"name":"Department of Nephrology Antwerp University Hospital Edegem Belgium"},{"name":"Laboratory of Experimental Medicine and Pediatrics University of Antwerp Antwerpen Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristof","family":"Bergs","sequence":"additional","affiliation":[{"name":"Department of Microbiology Antwerp University Hospital Edegem Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ester","family":"Philipse","sequence":"additional","affiliation":[{"name":"Department of Nephrology Antwerp University Hospital Edegem Belgium"},{"name":"Laboratory of Experimental Medicine and Pediatrics University of Antwerp Antwerpen Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rowena","family":"Vleut","sequence":"additional","affiliation":[{"name":"Department of Nephrology Antwerp University Hospital Edegem Belgium"},{"name":"Laboratory of Experimental Medicine and Pediatrics University of Antwerp Antwerpen Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annick","family":"Massart","sequence":"additional","affiliation":[{"name":"Department of Nephrology Antwerp University Hospital Edegem Belgium"},{"name":"Laboratory of Experimental Medicine and Pediatrics University of Antwerp Antwerpen Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie\u2010Madeleine","family":"Couttenye","sequence":"additional","affiliation":[{"name":"Department of Nephrology Antwerp University Hospital Edegem Belgium"},{"name":"Laboratory of Experimental Medicine and Pediatrics University of Antwerp Antwerpen Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veerle","family":"Matheeussen","sequence":"additional","affiliation":[{"name":"Department of Microbiology Antwerp University Hospital Edegem Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Abramowicz","sequence":"additional","affiliation":[{"name":"Department of Nephrology Antwerp University Hospital Edegem Belgium"},{"name":"Laboratory of Experimental Medicine and Pediatrics University of Antwerp Antwerpen Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,10,22]]},"reference":[{"issue":"2","key":"e_1_2_10_2_1","article-title":"Pre\u2010emptive treatment for cytomegalovirus viraemia to prevent cytomegalovirus disease in solid organ transplant recipients","volume":"2013","author":"Owers DS","year":"2013","journal-title":"Cochrane Database Syst 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