Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Cytomegalovirus (CMV) infection is the most common opportunistic viral infection after renal transplantation. Optimal duration of antiviral prophylaxis and the role of post prophylaxis surveillance in high risk patients is unclear.
We retrospectively reviewed CMV D+R- kidney and kidney-pancreas transplant recipients, induced by thymoglobulin and maintained on dual tacrolimus and mycophenolate therapy, for incidence and timing of CMV infection during and post antiviral prophylaxis. All patients received 6 months of valgancyclovir prophylaxis followed by monthly CMV NAAT monitoring for 3 months. Primary infection, viremia >200 copies/mL, was treated with oral valgancyclovir or IV ganciclovir.
A total of 35 high risk patients who underwent renal transplantation from January, 2013 to January, 2014 were followed until November, 2014 (all patients completed 9 months and 25 completed 12 months follow-up). Hospitalization rate and CMV titer of CMV infected patients is illustrated in the table 1.
|Total N (%)||Hospitalization N (%)||CMV PCR at diagnosis median(range)|
|Overall D+R- patients||35||7/35(20)||N/A|
|CMV infection (all)||16/35 (46)||7/16 (44)||6872(495->5500000)|
|< 6 months||6/16 (37.5)||3/6 (50)||43542(758-998674)|
|7-9 months||4/16 (25)||0 /4 (0)||1114(495-7070)|
|>9 months||6/16 (37.5)||4/6 (67)||926039(1301->5500000)|
CMV infection during the prophylaxis period was associated with under-dosing for GFR in 3 patients and not being on valgancyclovir in the remaining 3 patients (1 was pre-emptive approach, 1 was non-compliant, and the last patient had completed 5 months of therapy). All the 4 patients developing infection between 7-9 months were detected on routine post prophylaxis – 3 patients were asymptomatic and 1 had non-specific fatigue. Clinical suspicion for CMV infection led to detection of 4 out of 5 CMV infection beyond 9 months. All patients were treated with either IV or oral Ganciclovir. None of the patients died or lost their graft during follow up.
In conclusion: CMV infection remains common even with valganciclovir prophylaxis. Infection seen within 6 months was predominantly related to lower doses of valganciclovir or non-adherence. Monthly surveillance after prophylaxis appears to reduce the severity of infection and hospitalizations. Future studies should answer the optimal duration of CMV monitoring and prophylaxis in high risk patients.
To cite this abstract in AMA style:Bhattarai M, Puttarajappa C, Mour G, Wu C, Sood P, Shah N, Mehta R, Tevar A, Hariharan S. Incidence and Characteristics of CMV Infection in High Risk (D+R-) Kidney Transplant Recipients and the Utility of Monthly Surveillance After Routine Prophylaxis [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/incidence-and-characteristics-of-cmv-infection-in-high-risk-dr-kidney-transplant-recipients-and-the-utility-of-monthly-surveillance-after-routine-prophylaxis/. Accessed September 22, 2019.
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