Research Information System
Thesis Type: Expertise In Medicine
Institution Of The Thesis: Gazi Üniversitesi, Tıp Fakültesi, Turkey
Approval Date: 2015
Student: CENGİZ KARAÇİN
Supervisor: GALİP GÜZ
Abstract:Allograft rejection is one of the major problems of solid organ transplantation which need effective immunosuppression. Effective immunosuppression increases the occurrence of opportunistic infections. CMV infection is one of them. CMV infections or reactivations occur approximately 75 % of SOT recipients. It is well known that CMV infection has direct or indirect effects on the allografts. Therefore prophylactic therapy was recommended to SOT recipients who are in the high or intermediate risk group for the CMV infection. After the using of CMV PCR technique, which shows viral replications correctly and rapidly, preemptive therapy becomes an alternative strategy to prophylactic therapy. The aim of the study was comparing the effectiveness of preemptive screening and preemptive therapy as well as cost effectiveness. In this study, renal transplant recipients who were followed in Nephrology Department at Gazi University School of Medicine between January 1st, 2010 - January 1st, 2015 are evaluated retrospectively. Patients are divided into two groups as preemptive screening and prophylactic therapy. End-stage renal disease etiology, pre-transplantation treatment modality, immunosuppressive drugs, CMV IgG and IgM, CMV PCR, BUN, plasma creatinine levels and GFR values were obtained for all patients. The association between CMV infection, renal functions and pre-transplantation treatment modality was investigated retrospectively. CMV infection occurred 2 of 28 patients in preemptive screening group, 7 of 43 patients in prophylactic therapy group. There was no statistically significant difference between two groups for CMV infection occurrence (p=0,467). Mean value of BUN, Creatinine and GFR were consecutively 29,89(±16,34)mg/dL, 1,61(±0,85)mg/dL, 48,72(±28,23) mL/dk/1,73 m² before CMV infection. After CMV infection, mean value of BUN, Creatinine and GFR were measured as consecutively 35,77(±15,90)mg/dL, 1,80(±0,91)mg/dL, 47,11(±23,73) mL/dk/1,73 m² in all patients. There was no statistically significant differance for mean value of BUN, Creatinine, GFR between before and after CMV infection (consecutively p=0,260/0,202/0,680). Similarly there was no statistically significant differance for mean value of BUN, Creatinine, GFR between before and after CMV infection in preemptive screening and prophylactic therapy groups (in preemptive screening group consecutively p=0,381/0,473/0,258, in prophylactic therapy group p=0,566/0,658/0,779). Average monthly cost of each patient in preemptive screening and prophylactic therapy groups were consecutively 91,18(±33,10)/ 64,45(±25,43) TL. Average monthly cost of each patient in preemptive screening group is lower than each patient in prophylactic therapy group (p=0,017) In conclusion, our study shows that preemptive screening is effective as much as prophylactic therapy, and preemptive screening has lower cost than prophylactic therapy does.