Background: CMV serostatus D+/R- is an important risk factor for developing CMV infection post-transplant. Although CMV anti-viral prophylaxis (ppx) has reduced the incidence of CMV infection in LTX, concerns remain regarding hematologic effects and late-onset infection. The aim of this study was to determine the incidence of CMV disease in high-risk (D+/R-) LTX recipients who received low dose valganciclovir ppx.

Methods: The incidence of CMV disease (syndrome and end-organ disease) in adult D+/R- LTX recipients between 1/07 and 8/12 was retrospectively determined via chart review. Patients were excluded if multi-organ transplant recipient, did not receive valganciclovir for CMV ppx, or < 1 month f/u. Patients received valganciclovir 450 mg PO daily adjusted for renal fxn per institutional protocol for 90 days.

Results: 100 patients were evaluated; 94 patients met inclusion criteria. Patient characteristics are described in Table 1. Mean f/u time was 33 months. 19 cases (20%) of CMV disease were identified, 6 of which were classified as CMV end-organ disease (hepatitis = 1 and colitis/enteritits = 5) (Table 2). 16 of the 19 cases occurred w/in 6 months of transplant. No cases of CMV diseases developed while patients were on of ppx. 2 cases (2%) of CMV resistance to ganciclvoir were identified; one identified as an UL97 mutation and one as an UL54 mutation.

Conclusions: The incidence of CMV disease in D+/R- LTX recipients on low dose valganciclovir ppx is similar to that reported in other organ transplant recipients on standard dose ppx. Despite the use of low dose valganciclovir ppx, no breakthrough CMV disease occurred and ganciclovir-resistant CMV disease was rare in our study.

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