Low Level CMV Detection and Effectiveness of Low Dose Valganciclovir Prophylaxis in Intermediate-Risk Liver Transplant Recipients
1Department of Pharmacy, Medstar Georgetown University Hospital, Washington, DC, 2Georgetown University School of Medicine, Washington, DC, 3Medstar Georgetown University Hospital, Washington, DC
Meeting: 2020 American Transplant Congress
Abstract number: A-193
Keywords: Cytomeglovirus, Liver transplantation
Session Information
Session Name: Poster Session A: All Infections (Excluding Kidney & Viral Hepatitis)
Session Type: Poster Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: The purpose of this study is to assess the efficacy of low dose (450 mg/day) valganciclovir in preventing CMV infection in intermediate-risk liver transplant recipients (CMV IgG R+), while evaluating the impact of low level (detected but not quantifiable) CMV viremia detected on sensitive QNAT assay during and after the period of prophylaxis.
*Methods: This was a retrospective, single-center review of intermediate-risk liver transplant recipients (LTR) who were prescribed 450mg VGCV daily for three months post- transplant in addition to routine pre-emptive CMV monitoring. The primary outcome was the development of positive CMV viral load via QNAT testing during the first year. Secondary outcomes included CMV infection, CMV disease, CMV detected below the lower limit of quantification, breakthrough CMV while on VGCV, VGCV discontinuation, biopsy-proven rejection, VGCV-induced leukopenia, and mortality related to CMV. Outcomes were monitored for 12 months from transplant.
*Results: 108 LTR were initiated on low dose VGCV between January 2016 and June 2018 with an average duration of 96 days. During 1 year post-transplant, CMV was undetected in 60 patients (55%). 48 subjects had at least 1 detected CMV PCR (44%), with 19 of these detected during the period of prophylaxis. During the first year, 14 patients were medically treated for CMV infection (13%), which had a median onset of 127 days post- transplant. None of these cases occurred during the period of prophylaxis. CMV disease was diagnosed in 5 subjects (4.6%) with a median onset of 125 days post-transplant. Amongst the CMV disease cases, two subjects were diagnosed with CMV syndrome and three with CMV invasive disease (CMV colitis). Subjects who developed CMV had higher pre-transplant MELD scores than those that did not (28.4 vs 24.6, p=0.121). 10 subjects (9%) developed leukopenia (ANC<1500) during course of prophylaxis. There was no mortality related to CMV infection.
*Conclusions: Low dose VGCV 450 mg daily, despite not being recommended by recent CMV guidelines, is effective at preventing clinically significant CMV in intermediate risk (R+) LTR. While a high number of subjects had low level detectable CMV, the number of subjects with clinically significant CMV disease remained low.
To cite this abstract in AMA style:
Nolan A, Lovett B, Lindner B, Timpone JG. Low Level CMV Detection and Effectiveness of Low Dose Valganciclovir Prophylaxis in Intermediate-Risk Liver Transplant Recipients [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/low-level-cmv-detection-and-effectiveness-of-low-dose-valganciclovir-prophylaxis-in-intermediate-risk-liver-transplant-recipients/. Accessed November 22, 2024.« Back to 2020 American Transplant Congress