INTRODUCTION: Valganciclovir (VGC) is used for CMV ppx in kidney tx recipients (KTR). Based on previous PK and efficacy studies, a lower potential for AEs and reduced drug costs, our institution uses VGC 450 mg daily for 1 & 3 months in intermediate- (D+/R+, D-/R+) and high-risk (D+/R-) KTR, respectively. CMV infection rates at our institution in KTR were assessed and compared to previously reported results.

METHODS: This retrospective review examined D+/R-, D+/R+, and D-/R+ adult KTR transplanted between 10/1/2007-6/30/2010. Patients were excluded for any of the following: non-renal tx, graft loss/death within 30 days of tx, did not receive CMV ppx per protocol, or if clinical records were not available. CMV infection (CMV viremia detectable by PCR or tissue-invasive infections) 1 year after tx and patient/graft survival and acute rejection 2 years after tx were evaluated.

RESULTS: 70 KTR met inclusion (mean age = 45±16 years; 16 D+/R-, 32 D+/R+, 22 D-/R+; 54.3% female; 82.9% caucasian; 92.9% induction with antilymphocyte antibodies). 10 patients (14.3%) developed CMV infection within 1 year (median time to infection 107 days post-transplant) after tx. Rates of infection at 1 year and patient/graft survival and rejection rate at 2 years in each CMV risk group are described in Table 1. One D+/R- pt developed both tissue-invasive and ganciclovir-resistant infection. In those with CMV, 4 (40%) were on tacrolimus (Tac) and mycophenolate (MPA) while 6 (60%) were on Tac + MPA + prednisone at the time of infection.

CONCLUSIONS: Our findings suggest that VGC 450 mg daily for 1 or 3 months provides adequate ppx against CMV in intermediate-risk pts or high-risk pts, respectively. In D+/R- pts, the 1 year rate of infection appears to be less than the the 1 year rate of CMV disease reported in the IMPACT study for pts receiving 900 mg daily for 100 days (25% vs. 36.8%, respectively) but greater than in those receiving VGC 900 mg daily for 200 days (16.1%). However, patient/graft survival and acute rejection 2 years after tx do not appear to be adversely affected by our protocol.

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