Background: Valganciclovir (VGCV) 900 mg/day is the standard dose (SD) for CMV prophylaxis in patients with CrCl > 60 ml/min, although some transplant centers use a lower dose (LD) of 450 mg/day to reduce cost and incidence of leukopenia. It remains controversial whether LD VGCV is adequate for kidney transplant (KT) recipients at high risk of primary CMV infection (donor positive and recipient negative serostatus at transplant).

Methods: In April 2014, our program changed CMV prophylaxis for high risk KT recipients from LD to SD VGCV for 6 months. 88 consecutive adult KT recipients engrafted between 1/1/2013 and 11/30/2014 (excluding primary non-function) were analyzed. All received tacrolimus and mycophenolate ± prednisone for maintenance immunosuppression and were followed for one year. Time to CMV infection (viremia > 600 copies/mL or symptomatic disease) between the two regimens was compared.

Results: There was no statistically significant difference in recipient/donor characteristics or immunosuppression between the two periods.

By one year post-transplant, 13 recipients in the LD period (21%) and 5 recipients in the SD period (19%) had developed CMV infection.

Although statistical significance was not reached, more patients developed breakthrough infection or resistant CMV disease within the first 6 months while on LD prophylaxis.

Conclusion: Although the standard dose VGCV regimen did not decrease overall cumulative incidence of CMV infection in high risk KT recipients, it may be needed to prevent breakthrough infection and resistant CMV disease.

CITATION INFORMATION: Huang Y, Park J, Naik A, Kaul D. Standard Dose Valganciclovir Prophylaxis for High-Risk Kidney Transplant Recipients Reduces Incidences of Breakthrough and Resistant Cytomegalovirus Infection. Am J Transplant. 2016;16 (suppl 3).

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