Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Valganciclovir (VCV) prophylaxis is used to prevent primary cytomegalovirus (CMV) infection in CMV donor seropositive/recipient seronegative (D+/R-) solid organ transplant recipients (SOT). We examined the reasons for failure of VCV prophylaxis and effectiveness of provider education to minimize VCV underdosing.
*Methods: VCV prophylaxis (900mg daily adjusted for renal function) for 6 months is used in all D+/R- SOT at our institution. We examined the incidence of breakthrough CMV viremia in all D+/R- kidney and liver SOT in 2 time periods: 2013-15 pre-intervention (Gp1) and 2016-18 post-intervention (Gp2), focusing on factors related to VCV dosing or early cessation. Data from the Gp1 period suggested suboptimal VCV dosing. Targeted education was implemented in the post-intervention period to minimize VCV underdosing due to VCV-associated cytopenia. Use of G-CSF was promoted to minimize neutropenia.
*Results: Overall, 127 D+/R- SOT in Gp1 and 133 D+/R- SOT in Gp2 were evaluated. Less VCV dose modification occurred in the Gp2 17.4% vs. 36.4% in Gp1, though not significant (P 0.26). Early cessation of VCV was not significantly more in Gp2 vs. Gp1 (65.2% vs. 45.5% (P 0.19). Lower cytopenia was noted in Gp2 compared to Gp1 39.1% and 72.7% (P 0.08). However, 11 (8.7%) in the Gp1 and 23 (17.3%) in the Gp2 respectively had breakthrough CMV (P 0.04). Breakthrough was similar in Gp1 and Gp2 among kidney SOT (11.9% vs 15%) but greater in liver SOT (5% vs. 18.75%, P 0.01). 18.2% and 17.4 % of breakthroughs in Gp1 and Gp2 respectively occured on standard VCV dosage. Mean time to viremia was approximately 120 days, similar in both kidney and liver SOT.
*Conclusions: Targeted education minimized VCV dose reduction. However, significantly more CMV breakthroughs occurred due to early cessation of VCV, especially in liver SOT. Additional studies are warranted in defining optimal strategies for the prevention of primary CMV infection in high-risk D+/R- SOT.
|Gp1 (n=11)||Gp2 (n=23)|
|Dose Reduced||4 (36.4%)||4 (17.4%)|
|Drug Stopped||5 (45.5%)||15 (65.2 %)|
|Factors associated with early VCV cessation|
|Cytopenia||5 (100%)||9 (60%)|
|Impaired renal function||0||0|
|Cessation at 3 months||0||3 (20%)|
To cite this abstract in AMA style:Bizri LAl, Chaudhry ZS, Vahia A, Williams J, Lemos-Ramirez JC, Summers B, Patel A, Nagai S, Lanfranco OAbreu, Ramesh M, Busto RDel, Alangaden G. Evaluation of an Intervention to Reduce Underdosing of Valganciclovir for Primary Prophylaxis of Cytomegalovirus Infection in Donor Seropositive/Recipient Seronegative Kidney and Liver Transplant Recipients [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/evaluation-of-an-intervention-to-reduce-underdosing-of-valganciclovir-for-primary-prophylaxis-of-cytomegalovirus-infection-in-donor-seropositive-recipient-seronegative-kidney-and-liver-transplant-reci/. Accessed April 17, 2021.
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