Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Despite prophylaxis and preemptive strategies, CMV infection remains a common complication post liver transplant (LT). CMV surveillance after prophylaxis may improve outcomes, but supporting data and optimal methodology for this strategy are lacking. The aim of our study was to evaluate adherence and effectiveness of a 6-week surveillance period following risk based CMV prophylaxis.
*Methods: 354 consecutive CMV Intermediate Risk (IRG) or High Risk (HRG) adult LT recipients transplanted 5/14-5/18 were retrospectively reviewed for evidence of CMV DNAemia (CMV DNA >1000 units/ml regardless of symptoms), or CMV disease (evidence of CMV infection with attributable symptoms) within 1 year post LT. Surveillance adherence was defined by # of CMV DNA’s obtained compared to # specified per protocol and defined as: COMPLETE (3), PARTIAL (1-2) or NONE (0). Patients were excluded for death, graft failure or CMV treatment prior to prophylaxis completion. Groups were compared using multivariate logistic regression for factors associated with CMV disease. CMV risk-based prophylaxis and surveillance is summarized in Table 1.
|CMV Risk Category||Donor CMV IgG||Recipient CMV IgG||Viral Prophylaxis||Surveillance (initiated after completion of prophylaxis)|
|Intermediate Risk Group (IRG)||+ or –||+||Valganciclovir 450 mg daily x 3 months||Serum quant PCR q 2 weeks x 3|
|High Risk Group (HRG)||+||–||Valganciclovir 900 mg daily x 6 months||Serum quant PCR q 2 weeks x 3|
*Results: 268 patients (189 IRG and 79 HRG) were included. Surveillance adherence was 50% COMPLETE, 46% PARTIAL and 4% NONE. CMV DNAemia developed in 9 (4.8%) IRG and 30 (38%) HRG within the first year post LT, with the majority of these cases (6 and 23, respectively) detected during surveillance period. 3 (IRG) and 13 (HRG) patients became symptomatic (CMV disease) before preemptive therapy could be initiated. Preemptive therapy was used in 6 IRG and 17 HRG patients, with subsequent development of CMV disease in only 1 (HRG) patient. Thus, CMV disease was prevented in 6 (3.2%) IRG and 16 (20%) HRG. Per multivariate logistic regression, risk factors for CMV disease included HRG status, older age and lower body weight.
*Conclusions: As expected, a higher rate of DNAemia and disease in HRG occurred despite higher valganciclovir doses and longer prophylaxis duration. Successful preemptive therapy was implemented during surveillance in some patients, but surveillance was unsuccessful in preventing CMV disease in others. Outcomes could potentially be improved through greater protocol adherence, more frequent monitoring, or longer duration of surveillance
To cite this abstract in AMA style:Parrish N, Webb A, Kaiser T, Shah S, Anwar N, Luckett K. Evaluation of a Surveillance after Prophylaxis Strategy for Cytomegalovirus Prevention in Liver Transplant Recipients [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/evaluation-of-a-surveillance-after-prophylaxis-strategy-for-cytomegalovirus-prevention-in-liver-transplant-recipients/. Accessed December 3, 2020.
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