Purpose: Valganciclovir is used for the prevention of cytomegalovirus (CMV) infections in solid organ transplant (SOT) patients. Currently, no dosing recommendation is available for patients undergoing intermittent hemodialysis (IHD). At Stanford Hospital and Clinics (SHC), SOT patients on IHD receive CMV prophylaxis with valganciclovir dosed 450 mg two- or three-times weekly. This study evaluates the safety and effectiveness of valganciclovir prophylaxis in SOT recipients on IHD.

Methods: A retrospective review was conducted on lung, heart, liver, and/or kidney transplant patients from April 2008 – January 2011 at SHC. Inclusion criteria: SOT Patients receiving IHD for >14 days after transplant and on valganciclovir for CMV prophylaxis within one month of transplant. Descriptive statistics are used to quantify the prevalence of valganciclovir toxicity and CMV reactivation.

Results: Thirty-nine patients met inclusion criteria. Population characteristics: mean age-54 years; 54% male; transplants types comprised of: liver (59.0%), kidney (23.1%), lung (7.7%), heart (2.6%), and multiple organ transplants (10.2%); all patients received immunosuppressive therapy with tacrolimus (87.2%), anti-thymocyte globulin (79.5%), and mycophenolate (41.0%) as the most frequently used agents; most patients (74%) were at moderate/high risk for CMV infection based on CMV serology (i.e., donor (+ or -) /recipient +); most patients required IHD for ≤3 months (69.2%) while 25.6% required IHD for >12 months. Toxicities reported within 3 months after transplant: anemia (66.7%), thrombocytopenia (10.3%), leukopenia/neutropenia (2.6%). A majority of these patients also received combination immunosuppressive therapies known to produce similar adverse effects. Three patients (7.7%) experienced CMV viremia within the one year of observed data from transplant date, and zero patients experienced CMV disease. Viremia was detected after stopping IHD for two patients and during IHD for one patient. Two deaths occured within 12 months after transplant but were unrelated to CMV infection or valganciclovir toxicity.

Conclusions: This study suggests that it is safe and effective to use valganciclovir at 450 mg 2-3 times weekly in SOT patients on IHD. Minimal occurrences of CMV viremia and no cases of CMV disease were observed.

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