Evaluation of the Management of Cytomegalovirus in Kidney Transplant Recipients After Establishment of a Multidisciplinary Cytomegalovirus Workgroup
Hennepin County Medical Center, Minneapolis, MN
Meeting: 2022 American Transplant Congress
Abstract number: 992
Keywords: Infection, N/A, Reinfection, Viral therapy
Topic: Clinical Science » Infection Disease » 25 - Kidney Infectious Non-Polyoma & Non-Viral Hepatitis
Session Information
Session Name: Kidney Infectious Non-Polyoma & Non-Viral Hepatitis
Session Type: Poster Abstract
Date: Sunday, June 5, 2022
Session Time: 7:00pm-8:00pm
Presentation Time: 7:00pm-8:00pm
Location: Hynes Halls C & D
*Purpose: To assess the effectiveness of a multidisciplinary cytomegalovirus (CMV) workgroup in managing CMV in kidney transplant recipients.
*Methods: Retrospective chart review at a single transplant center was performed to compare management of CMV in kidney transplant recipients before and after establishment of a multidisciplinary CMV workgroup in 2018. The workgroup includes transplant pharmacists, nephrologists, coordinators, and an infectious disease physician, who perform weekly CMV DNA surveillance and CMV treatment assessment. All adult patients receiving a kidney transplant from January 2013 to November 2021 were included. Patients were included in the after CMV workgroup cohort if they were diagnosed with CMV while the workgroup was active. Patients were excluded from the after CMV workgroup cohort if the workgroup was not the primary healthcare team responsible for the management of CMV.
*Results: A total of 53 patients were identified (n=23 before and n=30 after). Forty-nine were first time transplant recipients. Most patients received anti-thymocyte globulin induction (73.9% before and 76.7% after). CMV D+/R- serostatus was not statistically different between cohorts (47.8% before versus 36.7% after). All patients received CMV prophylaxis at the time of transplant. CMV prophylaxis was discontinued early in 34.8% and 30% of patients in the before and after cohorts, respectively. Three patients died while on treatment due to causes unrelated to CMV. The median duration of primary CMV treatment was similar before and after establishment of the CMV workgroup. Secondary prophylaxis was prescribed less frequently and for a shorter median duration in the after cohort. Rates of recurrent infection were similar; however, the duration of secondary treatment was shorter in the after CMV workgroup cohort. Due to low viral load 4 patients did not receive treatment, however, immunosuppression was reduced and CMV resolved. Six additional patients with low viral load achieved CMV resolution without treatment or immunosuppression alteration.
*Conclusions: The establishment of a multidisciplinary CMV workgroup improved management of CMV in kidney transplant recipients by reducing inappropriate antiviral prescribing and improving provider communication.
| Before CMV Workgroup (n=23) | After CMV Workgroup (n=30) | p-value | |
| Duration of Primary Treatment, days, median (IQR) | 32 (21-49) | 31 (25-57) | 0.705 |
| Secondary Prophylaxis Provided, n (%) | 16 (69.6) | 11 (36.7) | 0.017 |
| Duration of Secondary Prophylaxis, days, median (IQR) | 58.5 (34-68.3) | 28 (19-55) | 0.026 |
| Recurrence, n (%) | 7 (30.4) | 11 (36.7) | 0.430 |
| Duration of Secondary Treatment, days, mean (SD) | 71.6 (46.5) | 25 (17.5) | 0.034 |
To cite this abstract in AMA style:
Boyle A, Spenningsby A, Rhodes H, Anderson-Haag T. Evaluation of the Management of Cytomegalovirus in Kidney Transplant Recipients After Establishment of a Multidisciplinary Cytomegalovirus Workgroup [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/evaluation-of-the-management-of-cytomegalovirus-in-kidney-transplant-recipients-after-establishment-of-a-multidisciplinary-cytomegalovirus-workgroup/. Accessed November 21, 2024.« Back to 2022 American Transplant Congress