Transplant centers' prophylaxis and monitoring strategies: a key determinant of current herpes and polyomavirus incidences - results from the DZIF kidney transplant cohort.

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Clinical Guidelines
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Sommerer C, Schröter I, Gruneberg K, Schindler D, Morath C, Renders L, Einecke G, Guthoff M, Heemann U, Schnitzler P, Zeier M, Giese T
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Urology & Nephrology
Obstetrics & Gynecology
Infectious Disease & Vaccines
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Obstetrics & Gynecology
Urology & Nephrology
Infectious Disease & Vaccines
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volume
26
ISSN
1471-2369
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{"article_title":"Transplant centers' prophylaxis and monitoring strategies: a key determinant of current herpes and polyomavirus incidences - results from the DZIF kidney transplant cohort.","author":"\"Sommerer, Claudia , Schr\u00f6ter, Iris , Gruneberg, Katrin , Schindler, Daniela , Morath, Christian , Renders, Lutz , Einecke, Gunilla , Guthoff, Martina , Heemann, Uwe , Schnitzler, Paul , Zeier, Martin , Giese, Thomas , Transplant Cohort of the German Center for Infection Research (DZIF Transplant Cohort) Consortium\"","journal_title":"BMC nephrology","issn":"1471-2369 ; Electronic","isbn":"","publication_date":"20250430","volume":"26","issue":"1","first_page":"218","page_count":"","accession_number":"40307706","doi":"10.1186\/s12882-025-04084-5","publisher":"BioMed Central","doctype":"Clinical Trial, Phase III; Journal Article","subjects":"","interest_area":["Urology & Nephrology"," Obstetrics & Gynecology"," Infectious Disease & Vaccines"],"abstract":"Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki and the International Conference on Harmonization Guidelines for Good Clinical Practice and was approved by the Ethics Committees of participating centers (Hannover Medical School Nr 6534, Medical Faculty of the University of Heidelberg Nr S-585\/2013, Medical Faculty of the TU Munich Nr 5926\/13, LMU Munich Nr 380 \u2212 15, University Hospital Tuebingen Nr327\/2014BO1). Written informed consent was obtained from all participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=40307706&authtype=shib&custid=ns346513","isPdfLink":true,"isSAML":false,"additionalInfo":{"Authored_By":"Sommerer C, Schr\u00f6ter I, Gruneberg K, Schindler D, Morath C, Renders L, Einecke G, Guthoff M, Heemann U, Schnitzler P, Zeier M, Giese T","Corporate_Authors":"Transplant Cohort of the German Center for Infection Research (DZIF Transplant Cohort) Consortium","Journal_Info":"Publisher: BioMed Central Country of Publication: England NLM ID: 100967793 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2369 (Electronic) Linking ISSN: 14712369 NLM ISO Abbreviation: BMC Nephrol Subsets: MEDLINE","Publication_Type":"Journal Article; Multicenter Study","Published_Date":"2025-04-30","Source":"BMC nephrology [BMC Nephrol] 2025 Apr 30; Vol. 26 (1), pp. 218. Date of Electronic Publication: 2025 Apr 30.","Languages":"English","Electronic_ISSN":"1471-2369","MeSH_Terms":"Kidney Transplantation*\/adverse effects , Polyomavirus Infections*\/epidemiology , Polyomavirus Infections*\/prevention & control , Herpesviridae Infections*\/epidemiology , Herpesviridae Infections*\/prevention & control , Cytomegalovirus Infections*\/prevention & control , Cytomegalovirus Infections*\/epidemiology , Postoperative Complications*\/prevention & control , Postoperative Complications*\/epidemiology , Postoperative Complications*\/virology, Humans ; Male ; Female ; Middle Aged ; Incidence ; Adult ; Cohort Studies ; Viremia\/epidemiology ; Viremia\/prevention & control ; Antiviral Agents\/therapeutic use ; Germany\/epidemiology ; Guideline Adherence ; Aged","Subjects":"Humans, Male, Female, Middle Aged, Incidence, Adult, Cohort Studies, Viremia epidemiology, Viremia prevention & control, Antiviral Agents therapeutic use, Germany epidemiology, Guideline Adherence, Aged, Kidney Transplantation adverse effects, Polyomavirus Infections epidemiology, Polyomavirus Infections prevention & control, Herpesviridae Infections epidemiology, Herpesviridae Infections prevention & control, Cytomegalovirus Infections prevention & control, Cytomegalovirus Infections epidemiology, Postoperative Complications prevention & control, Postoperative Complications epidemiology, Postoperative Complications virology","Title_Abbreviations":"BMC nephrology","Volume":"26"},"header":{"DbId":"mdl","DbLabel":"MEDLINE Ultimate","An":"40307706","RelevancyScore":"965","PubType":"Academic Journal","PubTypeId":"academicJournal","PreciseRelevancyScore":"964.772827148438"},"plink":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=40307706&authtype=shib&custid=ns346513&group=main&profile=eds","upload_link":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=40307706&authtype=shib&custid=ns346513&group=main&profile=eds"}
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1471-2369 ; Electronic
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["Sommerer C, Schr\u00f6ter I, Gruneberg K, Schindler D, Morath C, Renders L, Einecke G, Guthoff M, Heemann U, Schnitzler P, Zeier M, Giese T","Transplant Cohort of the German Center for Infection Research (DZIF Transplant Cohort) Consortium","Publisher: BioMed Central Country of Publication: England NLM ID: 100967793 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2369 (Electronic) Linking ISSN: 14712369 NLM ISO Abbreviation: BMC Nephrol Subsets: MEDLINE","Journal Article; Multicenter Study","2025-04-30","BMC nephrology [BMC Nephrol] 2025 Apr 30; Vol. 26 (1), pp. 218. Date of Electronic Publication: 2025 Apr 30.","English","1471-2369","Kidney Transplantation*\/adverse effects , Polyomavirus Infections*\/epidemiology , Polyomavirus Infections*\/prevention & control , Herpesviridae Infections*\/epidemiology , Herpesviridae Infections*\/prevention & control , Cytomegalovirus Infections*\/prevention & control , Cytomegalovirus Infections*\/epidemiology , Postoperative Complications*\/prevention & control , Postoperative Complications*\/epidemiology , Postoperative Complications*\/virology, Humans ; Male ; Female ; Middle Aged ; Incidence ; Adult ; Cohort Studies ; Viremia\/epidemiology ; Viremia\/prevention & control ; Antiviral Agents\/therapeutic use ; Germany\/epidemiology ; Guideline Adherence ; Aged","Humans, Male, Female, Middle Aged, Incidence, Adult, Cohort Studies, Viremia epidemiology, Viremia prevention & control, Antiviral Agents therapeutic use, Germany epidemiology, Guideline Adherence, Aged, Kidney Transplantation adverse effects, Polyomavirus Infections epidemiology, Polyomavirus Infections prevention & control, Herpesviridae Infections epidemiology, Herpesviridae Infections prevention & control, Cytomegalovirus Infections prevention & control, Cytomegalovirus Infections epidemiology, Postoperative Complications prevention & control, Postoperative Complications epidemiology, Postoperative Complications virology","BMC nephrology","26"]
Description
Background: Herpes- and polyomaviruses are major opportunistic pathogens after renal transplantation. Despite established guidelines, there is limited data on transplant centers' prophylaxis and monitoring strategies and centers' adherence to these guidelines and their impact on infection rates and patient outcomes.<br />Methods: This multicenter cohort study, conducted by the German Center for Infection Research, included 1035 kidney transplant recipients from five centers (01/2014-02/2021), focusing on herpes- and polyomavirus viremia within the first year and adherence to prophylaxis strategies.<br />Results: Among 1035 recipients, 26.6% developed herpes- or polyomavirus viremia, predominantly Cytomegalovirus (CMV, 14.3%) and BK-virus (BKV, 13.2%). BKV monitoring frequency was below guideline recommendations. Deviations from guidelines were most common in CMV D-/R- (34.6% with prophylaxis) and D-/R + groups (37.3% without prophylaxis), doubling CMV-incidence in D-/R+ (28.9% vs. 12.5%, p &lt; 0.01). In D+/R - group, six-month-prophylaxis reduced CMV-incidence compared to three months (22.5% vs. 38.4%, p &lt; 0.01). Breakthrough-viremia was most commonly observed in D+/R - recipients who received a six-month-prophylaxis. Overall, viremia was associated with higher incidence of acute rejection (31.9% vs. 17.6%, p &lt; 0.01), with most CMV-viremias occurring after rejection. CMV-viremia was associated with a higher risk of bacterial infection (HR = 1.77, [1.03;3.02]). Other herpesviruses were associated with a quadrupled risk for fungal infection (HR = 4.34, [1.03;18.30]) and the non-administration of CMV-prophylaxis (HR = 0.22, [0.11;0.47]). Graft survival and mortality were unaffected within the first year.<br />Conclusion: Clinical variability in guideline implementation drives high herpes- and polyomavirus infection rates with suboptimal outcomes. Future guidelines should focus on differentiated risk stratification to address breakthrough, post-prophylaxis, and post-rejection CMV, and include protocols for the early detection of secondary infections.<br /> (© 2025. The Author(s).)
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