Evaluation of Low Dose Valganciclovir for the Prevention of Cytomegalovirus in Liver Transplant Recipients.

C. Payne,¹ J. Melaragno,¹ D. Hutchinson,¹ T. Babu,² P. Prasad,^2,3 T. Dick.¹

¹Pharmacy, University of Rochester Medical Center, Rochester, NY
²Division of Infectious Diseases, University of Rochester Medical Center, Rochester, NY
³Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, Rochester, NY

Meeting: 2017 American Transplant Congress

Abstract number: B196

Keywords: Cytomeglovirus, Efficacy, Liver, Viral therapy

Session Information

Session Name: Poster Session B: Liver Retransplantation and Other Complications

Session Type: Poster Session

Date: Sunday, April 30, 2017

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall D1

BACKGROUND: Cytomegalovirus (CMV) causes significant morbidity and mortality following orthotopic liver transplantation (OLT). Valganciclovir (VGCV) is used to prevent CMV, but at labeled doses can cause hematologic toxicities. Prior studies in OLT have demonstrated comparable efficacy of low dose (LD)-VGCV to oral ganciclovir, but the efficacy of LD-VGCV compared to standard dose (SD) VGCV has not been established. Herein we describe the first report comparing LD-VGCV to SD-VGCV for the prevention of CMV in OLT.

METHODS: A case-control study was conducted in adult patients transplanted between March 1, 2011 and March 31, 2015. Patients with high (donor [D] +/ recipient [R] -) or intermediate (D+/R+ or D-/R+) risk CMV serostatus were included. Characteristics and outcomes were compared between those who developed CMV and those who did not in the first 12 months after OLT. VGCV exposure was investigated as a covariate.

RESULTS: Seventy-two patients were included; 45 (62.5%) were male, 59 (81.9%) were Caucasian and 58 (80.6%) were over the age of 50 years. CMV serostatus was 22.2% D+/R- and 77.8% were D+/R+ or D-/R+. Nineteen (26.4%) patients developed CMV (33.3% SD-VGCV vs. 19.4% of LD-VGCV patients; p=0.18) and the remaining 53 patients served as controls. Thirty-six (50%) patients received LD-VGCV; all others received SD-VGCV. Multivariate logistic regression did not reveal an increased risk of CMV with LD-VGCV exposure (p=0.587) when controlling for other risk factors including CMV serostatus. Of note, only 3 patients in the LD-VGCV group were D+/R-, and 2/3 developed CMV during follow-up. Rates of biopsy proven acute rejection, infection, drug resistant CMV, and adverse events were similar between VGCV groups.

CONCLUSION: LD-VGCV was not associated with an increased risk of CMV and has similar efficacy to SD-VGCV in intermediate risk, adult OLT recipients. However, further evaluation is warranted in D+/R- recipients who were underrepresented in this study.

CITATION INFORMATION: Payne C, Melaragno J, Hutchinson D, Babu T, Prasad P, Dick T. Evaluation of Low Dose Valganciclovir for the Prevention of Cytomegalovirus in Liver Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Payne C, Melaragno J, Hutchinson D, Babu T, Prasad P, Dick T. Evaluation of Low Dose Valganciclovir for the Prevention of Cytomegalovirus in Liver Transplant Recipients. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/evaluation-of-low-dose-valganciclovir-for-the-prevention-of-cytomegalovirus-in-liver-transplant-recipients/. Accessed November 21, 2024.

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