%0 Journal Article %A Arturo Blazquez-Navarro %A Chantip Dang-Heine %A Chris Bauer %A Nicole Wittenbrink %A Kerstin Wolk %A Robert Sabat %A Oliver Witzke %A Timm H. Westhoff %A Birgit Sawitzki %A Petra Reinke %A Oliver Thomusch %A Christian Hugo %A Nina Babel %A Michal Or-Guil %T Sex-associated differences in cytomegalovirus prevention: Prophylactic strategy is associated with a strong kidney function impairment in female renal transplant patients %D 2019 %R 10.1101/726968 %J bioRxiv %P 726968 %X Cytomegalovirus (CMV) syndrome or disease, a serious health hazard after renal transplantation, can be prevented using the antiviral drug (val)ganciclovir. (Val)ganciclovir is typically administered following a prophylactic or a pre-emptive strategy. The prophylactic strategy entails early universal administration, the pre-emptive strategy early treatment in case of infection. However, it is not clear which strategy is superior with respect to transplantation outcome and viral clearance. We have retrospectively analysed 540 patients from the multicentre Harmony study: 308 were treated according to a prophylactic, 232 according to a pre-emptive strategy. As expected, we observed an association of prophylactic strategy with lower incidence of CMV syndrome, delayed onset and lower viral loads compared to the pre-emptive strategy. However, the prophylactic strategy was associated with higher incidence of acute rejection (P=0.002) and – for female patients – a strong impairment of glomerular filtration rate (eGFR) one year post-transplant (P<0.001, median difference: 18.5 mL·min−1·1.73m−2). Additionally, the prophylactic strategy was associated with increased incidence of severe BK virus reactivation. Our results suggest for the first time that the prophylactic strategy might lead to inferior transplantation outcomes, providing evidence for a strong association with sex.ClinicalTrials.gov number: NCT00724022 %U https://www.biorxiv.org/content/biorxiv/early/2019/08/06/726968.1.full.pdf