Purpose: The aim of this study was to compare the rate of cytomegalovirus (CMV) infection after kidney transplantation in high and intermediate risk patients who received subtherapeutic versus therapeutic or supratherapeutic valganciclovir prophylaxis.

Methods: This was a retrospective, single center, chart review of patients who received a kidney transplant between February 1st, 2013 and March 31st, 2015. Patients at low risk of CMV infection were excluded. Antiviral dosing was assessed and defined as subtherapeutic, therapeutic, or supratherapeutic based on institutional guideline at discharge then monthly through discontinuation of prophylaxis. The primary outcome was the rate of CMV infection in patients who received subtherapeutic valganciclovir prophyalxis as compared to patients who did not. Secondary outcomes included incidence of CMV infection, time course to CMV infection, incidence of biopsy proven acute rejection (BPAR) and rate of leukopenia. Patients had at least 12 months of follow up from time of discontinuation of prophylaxis.

Results: We evaluated 134 patients during the study period and excluded three patients for inadequate follow up resulting in inclusion of 131 patients. Thirty-three patients (25.2%) received subtherapeutic valganciclovir during at least one time point. Patients who received subtherapeutic valganciclovir were more likely to receive anti-thymocyte globulin (ATG) and a living donor transplant, but were otherwise similar at baseline. CMV infection occurred in 11 patients (33%) who were subtherapeutic and 25 patients (26%) who were not subtherapeutic (p=0.519). The median time from transplant to infection in patients who were subtherapeutic and patients who were not subtherapeutic were 221 and 208 days and the median time from discontinuation of prophylaxis to infection were 42 and 97 days, respectively. BPAR occurred in 10 patients (30%) who were subtherapeutic and in 16 patients (16%) who were not subtherapeutic (p=0.137). Leukopenia occurred in 10 patients who were subtherapeutic and in 22 patients who were not subtherapeutic.

Conclusion: Rates of CMV infection were similar between those who were subtherapeutic and those who were not subtherapeutic. Patients who developed CMV after being subtherapeutic with valganciclovir had a shorter time from discontinuation of prophylaxis to CMV infection.

CITATION INFORMATION: Belfield K, Cohen E, Malinis M, Baghban A. Rates of CMV Infection in Kidney Transplant Recipients Who Received Subtherapeutic Valganciclovir Prophylaxis. Am J Transplant. 2017;17 (suppl 3).

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