Risk of Cytomegalovirus Infection after 3 or 6 Months of Valganciclovir Prophylaxis among Donor-Seropositive, Recipient-Seronegative Heart Transplant Recipients
Bibliographic record
Abstract
Background: Cytomegalovirus (CMV) disease is frequent following heart transplant, especially among patients with donor-seropositive, recipient-seronegative (D+/R–) CMV status. Valganciclovir prophylaxis for 3 to 6 months is recommended, but few data support the use of 6 rather than 3 months of prophylaxis for patients who have undergone heart transplant. Objective: To compare the risk of CMV infection and a first occurrence of CMV disease after heart transplant among CMV D+/R– patients who received 3 or 6 months of prophylaxis in the first year after transplant. Methods: This retrospective analysis included every D+/R– heart transplant recipient at the study centre between October 2015 and October 2022. Patients had to have a minimum of 1 year of follow-up for inclusion. Results: Thirty-five patients met the inclusion criteria. The duration of valganciclovir prophylaxis (determined by the medical team) was 3 months for 22 patients and 6 months for 13 patients. CMV infection occurred in 68.2% (15/22) and 30.8% (4/13) of the 3-month and 6-month groups, respectively (risk difference 37.4%, 95% confidence interval [CI] 1.75 to 65.8, p = 0.04). CMV disease occurred in 54.5% (12/22) of patients who received 3 months of prophylaxis and 23.1% (3/13) of those who received 6 months of prophylaxis (risk difference 31.4%, 95% CI –3.7 to 59.4, p = 0.09). Most CMV infections and diseases occurred in the 3 months after the end of prophylaxis. Conclusions: After heart transplant, CMV D+/R– patients who received 3 months of prophylaxis had a higher risk of CMV infection and a non- statistically significant higher risk of CMV disease relative to those who received 6 months of prophylaxis. Keywords: cytomegalovirus, heart transplant recipients, prophylaxis, valganciclovir RÉSUMÉ Contexte : La maladie à cytomégalovirus (CMV) est fréquente après une transplantation cardiaque, en particulier chez les patients ayant un statut CMV donneur-séropositif, receveur-séro-négatif (D+/R–). Une prophylaxie à base de valganciclovir pendant 3 à 6 mois est recommandée, mais peu de données soutiennent l’utilisation de 6 mois de prophylaxie plutôt que 3 mois chez les patients ayant subi une transplantation cardiaque. Objectif : Comparer le risque d’infection à CMV et la survenue d’une première maladie à CMV après une transplantation cardiaque chez les patients CMV D+/R– ayant reçu 3 ou 6 mois de prophylaxie au cours de la première année suivant la transplantation. Méthodologie : Cette analyse rétrospective comprenait tous les bénéficiaires d’une de transplantation cardiaque D+/R– au centre d’étude entre octobre 2015 et octobre 2022. Le suivi des patients devait être d’au moins un an pour que les patients soient inclus. Résultats : Trente-cinq patients répondaient aux critères d’inclusion. La durée de la prophylaxie par valganciclovir était de 3 mois pour 22 patients, et de 6 mois pour 13 patients, selon l’équipe médicale. Une infection à CMV est survenue dans 68,2 % (15/22) et 30,8 % (4/13) des groupes de 3 mois et de 6 mois, respectivement (différence de risque de 37,4 %, intervalle de confiance à 95 % [IC] de 1,75 à 65,8, p = 0,04). La maladie à CMV est survenue chez 54,5 % (12/22) des patients ayant reçu 3 mois de prophylaxie et 23,1 % (3/13) de ceux ayant reçu 6 mois (différence de risque de 31,4 %, IC à 95 % de –3,7 à 59,4, p = 0,09). La plupart des infections et des maladies sont survenues dans les 3 mois suivant la fin de la prophylaxie. Conclusions : Après une transplantation cardiaque, les patients CMV D+/R– ayant reçu 3 mois de prophylaxie présentent un risque plus élevé d’infection à CMV et un risque plus élevé non statistiquement significatif de maladie à CMV par rapport à ceux ayant reçu 6 mois de prophylaxie. Mots-clés : cytomegalovirus, transplantés cardiaques, prophylaxie, valganciclovir
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".