Background: Prophylaxis against cytomegalovirus (CMV) is recommended in high-risk patients (CMV D+/R-) and those who are CMVR+ and getting T-cell depletional therapy. It is unclear if delaying the initiation of prophylaxis has an impact on infection post-transplant. Additionally, the agents used are associated with significant cost. The purpose of this study is to determine the effects of early versus late CMV prophylaxis in kidney and kidney/pancreas transplant recipients.

Methods: Retrospective, single center study of patients transplanted between 6/2014-9/2016 with early versus late (>72hrs after txp) initiation of CMV prophylaxis. High-risk patients received prophylaxis for 6 mos. The primary endpoint was the incidence of CMV infection within 1 yr defined by a positive DNA PCR. Secondary endpoints included time to CMV infection, incidence/time to CMV disease, and incidence/time to tissue invasive disease within 1yr.

Results: A total of 149 patients were included (114 early / 35 late) with demographics listed in table 1. CMV infection occurred in 61% versus 54% in the early versus late group (p=0.5). When excluding low-level viremia (PCR < 200iu/ml), infection occurred in 30% versus 23% in the early versus late group (p=0.5). The median days to starting prophylaxis was 0 and 5 in the early and late group, respectively (p=0.001) with 54% starting after hospital discharge. Secondary endpoints are listed in table 2. CMV resistance was found once in each group and responded to treatment.

Conclusion: In this cohort the timing of prophylaxis initiation did not have an impact on CMV infection or disease. Infection was common in both groups and mostly occurred once prophylaxis was stopped. Delaying the start of prophylaxis could result in cost savings during initial hospitalization.

CITATION INFORMATION: Harris M., Byrns J., Gommer J., Laub M., Ellis M. Early versus Late Cytomegalovirus Prophylaxis after Kidney Transplant Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress