Purpose: To evaluate the incidence of cytomegalovirus (CMV) infection in intestinal transplant recipients after a change in an antiviral regimen.

Methods: This was a retrospective review including intestinal transplant recipients at an academic medical center from January 1^st 2004 through June 30, 2016. Patients were included if they received an intestinal (isolated or multivisceral) transplant, and received viral prophylaxis within the first 30 days post-transplant. Prior to 2011, antiviral therapy (ganciclovir, valganciclovir, or acyclovir and cytomegalovirus immune globulin) was given at standard doses for 1 year post-transplant based on donor and recipient serostatus (group 1). After 2011, antiviral therapy doses were reduced and duration was shortened to six months for high risk (CMV D+/R-) and three months for moderate (CMV R+) and low (CMV D-/R-) risk patients (group2). The primary outcome was the incidence of CMV infection. Secondary outcomes included tissue-invasive CMV disease, CMV resistance, allograft rejection, graft loss, adverse effects from antiviral prophylaxis, and mortality.

Results: Sixty-two transplant recipients were included in this analysis (85% pediatric and 15% adult). No differences were detected in the incidence of CMV infection between groups 1 and 2 (23% vs 16%, P=0.75). Of documented CMV infections, 75% occurred while patients were on viral prophylaxis, with no difference detected between groups 1 and 2 (86% vs 60%, P=0.40). No differences were detected in CMV tissue-invasive disease (10% vs 0%, P=0.24); CMV resistance (6% vs 13%, P=0.67); allograft rejection (29% vs 32%, P=1.00); graft loss (6.5% vs 0%, P=0.49); or adverse effects (65% vs 52%, P=0.30) between groups 1 and 2 respectively. A total of 13 (42%) patients died within the study time frame. Three patients (10%) in group 1 and 2 patients (6%) in group 2 died due to CMV infection.

Conclusion: Intestinal transplant recipients receiving a decreased dose and duration of CMV antiviral prophylaxis do not appear to be at increased risk of CMV infection or CMV-related complications compared to those receiving higher doses for longer durations after transplant.

CITATION INFORMATION: Eley M, Keck M, Collier D, Vacha M. Evaluation of Cytomegalovirus Prophylaxis Regimens in Intestinal Transplant Recipients: A Single Center Experience. Am J Transplant. 2017;17 (suppl 3).

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