Does Prophylaxis Strategy Matter? CMV Reactivation in Moderate Risk (R+) Heart Transplant Recipients
Pharmacy, Tampa General Hospital, Tampa, FL.
Meeting: 2015 American Transplant Congress
Abstract number: B8
Keywords: Cytomeglovirus
Session Information
Session Name: Poster Session B: "A Descent into the Maelstrom": Complications After Heart Transplantation
Session Type: Poster Session
Date: Sunday, May 3, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Purpose: CMV is a significant complication in heart transplant recipients (HTR). Little evidence exists to guide prophylaxis in moderate risk (R+) patients.
Methods: An IRB-approved review of all moderate risk (recipient IgG+) HTR transplanted from 10/2011-8/2013 was conducted at a single center; pertinent data was collected for the first post-transplant year. CMV reactivation (CMV-R) was defined as a treated viremia (>200 copies/mL) or tissue-invasive disease (pathologically proven). All R+ recipients who received thymoglobulin induction (used to delay initiation of tacrolimus) received 3 months of valganciclovir followed by 3 months of valacyclovir (THYMO/VGCV); R+ HTR receiving steroid-only induction received 6 months of valacyclovir (STER/VAC).
Results: 51 R+ HTR were included. The 1-year CMV-R rate was 23.5% (12/51); all CMV-R was treated viremia. Demographics and donor status did not affect reactivation; immunosuppression was similar at time of prophylaxis stop (Table 1). Incidence of CMV-R in R+ HTR receiving THYMO/VGCV was significantly lower than R+ HTR receiving STER/VAC (12.1% vs 44.4%, p=0.009). Time to CMV-R was also longer in THYMO/VGCV (p<0.001). Rejection following CMV-R was higher in STER/VAC. Viral load was similar between groups, and readmission was required in 25% of cases (Table 2).
| Overall Cohort (N=51) | CMV Reactivation (N=12) | No CMV Reactivation (N=39) | p | |
| Age, mean (range) | 56.3 (28-70) | 57.9 (39-70) | 55.8 (28-70) | 0.6 |
| Male Gender, n (%) | 35 (68.6) | 7 (58.3) | 28 (71.8) | 0.38 |
| Caucasian race, n (%) | 34 (66.6) | 9 (75) | 25 (64.1) | 0.48 |
| Donor status CMV + | 30 (58.8) | 7 (58.3) | 23 (59) | 0.91 |
| Mean MMF dose at ppx d/c, mg | 1465 | 1091 | 1594 | 0.067 |
| Mean tacrolimus level at ppx d/c, ng/mL | 11.4 | 9.18 | 12.1 | 0.038 |
| Median time from transplant to treated rejection, days | 43.5 | 45 | 40 | 0.12 |
| THYMO/VGCV | STER/VAC | p | |
| CMV reactivation, n (%) | 4/33 (12.1) | 8/18 (44.4) | 0.009 |
| Mean thymoglobulin dose, mg/kg | 2.69 | 0 | <0.001 |
| Time to CMV reactivation, days | 197 | 48 | <0.001 |
| Rejection prior to CMV, n (%) | 1/4 (25) | 3/8 (37.5) | 0.22 |
| Rejection after CMV, n (%) | 0/4 (0) | 1/8 (12.5) | <0.001 |
| Readmission for CMV, n (%) | 1/4 (25) | 2/8 (25) | 0.14 |
| Median viral load | 809.5 | 1066.5 | 0.19 |
Conclusions: A high rate of CMV-R was found in this R+ HTR population, and use of STER/VAC prophylaxis led to early reactivation and increased rejection. This is the first study to evaluate CMV-R specifically in the R+ HTR population, and reinforces the need for aggressive CMV prophylaxis regardless of induction strategy utilized.
To cite this abstract in AMA style:
Liu E, Doligalski C. Does Prophylaxis Strategy Matter? CMV Reactivation in Moderate Risk (R+) Heart Transplant Recipients [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/does-prophylaxis-strategy-matter-cmv-reactivation-in-moderate-risk-r-heart-transplant-recipients/. Accessed November 21, 2024.« Back to 2015 American Transplant Congress