*Purpose: Cytomegalovirus (CMV) is the most common viral infection after solid organ transplant (SOT) and is associated with significant morbidity and mortality. Valganciclovir (VGCV) is the most commonly used antiviral for prophylaxis (PPX), though in patients with end stage renal disease (ESRD) requiring hemodialysis (HD) there are currently minimal data to guide dosing. Current guidelines recommend 100 mg given post-HD based on pharmacokinetic data. In the absence of clear clinical outcomes-supported dosing, this study aims to assess the efficacy and safety of VGCV 450 mg three times/week for CMV PPX in ESRD SOT recipients receiving HD.

*Methods: We performed a retrospective review of all adult liver, heart, and lung transplant recipients with ESRD requiring renal replacement post-transplant. VGCV was used for universal CMV PPX dosed 450 mg three times/week for a duration of 12 months in lung recipients and 3 months in heart and liver recipients per institution protocol. Patients were excluded if they received a kidney or multi-organ transplant that included a kidney, were a CMV high-risk liver recipient, required renal replacement for fewer than 28 days, or died within 28 days of transplant. The primary outcome was the rate of CMV infection while on three times/week VGCV PPX. Secondary outcomes included occurrence of leukopenia and thrombocytopenia, rates of CMV infection while not on PPX, type of CMV infection, CMV resistance, and recurrent CMV infections within one year post-transplant.

*Results: Thirty-seven patients were included in the analysis. Baseline characteristics and results are listed in Tables 1 and 2, respectively. No patients developed CMV infection while on VGCV PPX. The overall rate of CMV infection at one year post-transplant was 16.2% (n=6). These infections occurred in heart and liver recipients at a median of 139 days post-transplant (IQR 123-134). Types of CMV infection are depicted in Table 2. There were no cases of resistant or recurrent infections. Leukopenia occurred in 43% of patients while on VGCV PPX, of which 38% received a granulocyte colony-stimulating factor. Thrombocytopenia occurred in 37% of patients while on VGCV PPX.

*Conclusions: VGCV dosed three times weekly in SOT recipients with ESRD receiving HD is effective in prevention of CMV infection; however, this data cannot be extrapolated to a high-risk population. Though more than one-third of patients developed leukopenia or thrombocytopenia while on VGCV PPX, VGCV cannot be implicated as the sole cause. Further larger prospective studies comparing dosing strategies are needed to confirm these findings.

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