Background

Although many centers use secondary prophylaxis to prevent relapse following the treatment of CMV disease in kidney transplant recipients (KTR), there is limited data to support this practice.

Methods

A retrospective study of KTR with CMV disease at our institution from 2001-9 was performed. Patients with CMV infection (i.e. asymptomatic viremia) were not included. Data was collected regarding CMV diagnosis, treatment, secondary prophylaxis, and relapse. Secondary prophylaxis was defined as the continuation of a lower dose of valganciclovir upon resolution of CMV disease.

Results

Twenty-four KTR were included: 15 with CMV syndrome and 9 with tissue-invasive disease. All patients had received primary CMV prophylaxis with either oral ganciclovir or valganciclovir for a median of 176 days after transplant. The median time from transplant to CMV disease was 239 days (range 101-2222). The median baseline CMV viral load was 35,850 copies/mL (range <600 to >100,000). Patients received treatment doses of antivirals for a median of 37 days (range 10-113). The median time from CMV diagnosis to eradication of viremia was 26 days (range 9-149). Of the 24 patients, 18 (75%) received secondary prophylaxis for a median of 54 days (range 10-231). Within a median follow-up time of 2.8 years after completion of initial CMV treatment, 6 (25%) patients developed relapse: 4/18 (22%) after secondary prophylaxis and 2/6 (33%) with no secondary prophylaxis. Median time to relapse was 166 days (range 10-753) after treatment discontinuation. No patients developed relapse while receiving secondary prophylaxis, and there was no ganciclovir-resistant CMV observed. All relapses were successfully treated, and all 24 patients were alive at the time of last follow-up. Donor/recipient CMV status, initial CMV viral load, time to clearance of CMV viremia, treatment for transplant rejection, and lack of secondary prophylaxis were not significant predictors of relapse.

Conclusions

Our study demonstrates that CMV relapse may still be a problem in KTR despite treatment until eradication of viremia. However, secondary prophylaxis was not significantly associated with a reduced rate of CMV relapse in our single center study. Limitations include lack of randomization and small sample size. A prospective, randomized trial is needed to definitively assess the role of secondary prophylaxis in preventing CMV relapse in KTR.

« Back to 2013 American Transplant Congress