Immediate vs Delayed Initiation of CMV Prophylaxis…Safe and Cost Beneficial?
University of Utah Health Care, Salt Lake City, UT
Meeting: 2017 American Transplant Congress
Abstract number: A289
Keywords: Cytomeglovirus, Economics, Kidney transplantation
Session Information
Session Name: Poster Session A: Viral Conundrums
Session Type: Poster Session
Date: Saturday, April 29, 2017
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall D1
Background: Recommendations differ on when to initiate valganciclovir (VGCV) for CMV prophylaxis (ppx) after tx. Current labeling states within 10 days of tx. We evaluated the impact of delayed VGCV ppx vs immediate initiation of VGCV at time of tx. Methods: This was a single-center retrospective study of kidney (KTR) and pancreas (PTR) tx recipients tx'd from 1/2012-8/2013 (immediate cohort[IC]) and 1/2014-8/2015 (delayed cohort [DC]) followed for 12 months. All KTR received VGCV per protocol: (a) if R+ VGCV 450 mg/day x 1 mo or (b) if D+/R- VGCV 450 mg/day x 3 mo. PTR received VGCV 900 mg daily x 3 mo (R+) or x 6 mo (D+/R-). Standard IS was TAC, MPA and indefinite prednisone.
Clinical Characteristics
| IC (n=49) | DC (n=125) | |
| Demographics | ||
| Female | 28 (57%) | 48 (38%) |
| Average age | 45 | 46 |
| CMV D+/R- | 5 (10%) | 20 (16%) |
| Prior transplant | 10 (20%) | 27 (22%) |
| ≥ 2 prior transplants | 5 (10%) | 2 (2%) |
| Transplant type | ||
| Kidney transplant alone | 49 (100%) | 109 (87%) |
| Pancreas transplant alone | 0 | 5 (4%) |
| Simultaneous pancreas kidney transplant | 0 | 11 (9%) |
| Induction agent | ||
| Thymoglobulin | 43 (88%) | 21 (17%) |
| Alemtuzumab (C-1H) | 4 (8%) | 57 (46%) |
| Methylprednisolone alone | 2 (4%) | 47 (37%) |
Results: Pts were well matched between groups. Induction therapy with C-1H or methylprednisone alone was more common in DC vs. thymo in IC. Mean time to VGCV initiation in the DC was 5.26 days compared to <1 day in the IC. CMV viremia was similar between groups (DC 21% vs. IC 16%, p=0.45). Pts in DC took longer to develop CMV viremia (mean 135 vs. 95 days). A hx of 2 prior tx (OR 5.4, 95% CI 1.2-25.8) and CMV D+/R- serostatus (OR 5.3, 95% CI 2.2-13.2) were associated with significantly higher risk of CMV viremia. Induction with C-1H did not impact incidence of CMV viremia (OR 1.9, 95% CI 0.9-4.0). Incidence of tissue invasive disease (DC 1% vs. IC 0%) and ganciclovir resistance (DC 1% vs. IC 2%) were similar. There was one BPAR in each group. Delayed VGCV ppx did provide approx $33,781/yr in drug savings.
Conclusion: Delayed CMV ppx did not result in increased rates of CMV viremia or negatively impact 1 yr pt outcomes, but does result in a reduction in drug cost during tx hospitalization. Further study is warranted to validate these findings.
CITATION INFORMATION: Cotiguala L, Carlson A, Truax C, Sirandas B, Hall I, Smith L. Immediate vs Delayed Initiation of CMV Prophylaxis…Safe and Cost Beneficial? Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Cotiguala L, Carlson A, Truax C, Sirandas B, Hall I, Smith L. Immediate vs Delayed Initiation of CMV Prophylaxis…Safe and Cost Beneficial? [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/immediate-vs-delayed-initiation-of-cmv-prophylaxis-safe-and-cost-beneficial/. Accessed November 22, 2024.« Back to 2017 American Transplant Congress