Low Dose Valganciclovir Is an Effective Prophylaxis Against Cytomegalovirus in High Risk (Donor+/ Recipient-) Kidney Transplants Recipients
1Surgery/Transplant, Rush University Medical Center, Chicago
2Pharmacy, Rush University Medical Center, Chicago
3Medicine/Infectious Diseases, Rush University Medical Center, Chicago.
Meeting: 2015 American Transplant Congress
Abstract number: A81
Keywords: Cytomeglovirus, Ganciclovir, Kidney transplantation, Prophylaxis
Session Information
Date: Saturday, May 2, 2015
Session Name: Poster Session A: Infection
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Exhibit Hall E
Introduction: Universal prophylaxis against Cytomegalovirus (CMV) disease is endorsed in high risk seronegative kidney (K) transplant (TX) recipients of organs from seropositive donors (D+/R-) using valganciclovir (VGCV) (900 mg daily) at minimum of 100 days post-KTX. Concerns for cost and toxicities in addition to suggestion of adequate systemic ganciclovir exposure with low dose VGCV (450 mg daily) have prompted our center to adopt this low dose for prophylaxis. We aim here to evaluate the efficacy of this practice.
Methods: Adult KTX recipients from 8/2008 to 8/2014 with D+/R- were retrospectively reviewed (n=52). Patients with follow up < 6 month, incomplete records or used other prophylaxis were excluded (n=13). Primary outcome was occurrence of CMV disease.
Results: Recipients (n=39) were predominantly Caucasians (n=18) males (n=27) with a mean age of 47 years, mean BMI 26 Kg/m2, 8 were pre-emptive and 5 had simultaneous TX (4 pancreas +1 heart). The donors were largely standard criteria (4 ECD, 4 DCD) with 4 living donors. Donors were mostly Caucasians (n=19) males (n=24) with mean cold ischemia time of 16 hours. Six patients had delayed graft function. Mean follow up was 32 month (range 6-67). CMV DNAemia was diagnosed in 6 patients (15.4%) this occurred on average 13 months from TX with a mean peak viral load of 39,146 copies/ml at their initial presentation (using PCR. Ref < 300). Three patients were on prophylaxis. One patient presented with CMV syndrome, the other 5 were asymptomatic, 1 of asymptomatic patients developed recurrent DNAemia and later CMV syndrome, thus in total CMV disease occurred in 2/39 (5.1%), both of them were late onset disease. Another patient despite being asymptomatic developed breakthrough DNAemia and resistance requiring foscarnet for therapy. No graft loss or patient death was directly related to CMV disease.
Conclusions: Low dose VGCV is an effective prophylaxis in CMV high risk (D+/R-) KTX. The rate of CMV disease in this study is equivalent to those reported in the literature using the higher dose with the added benefit of lower cost and less toxicities.
To cite this abstract in AMA style:
Fayek S, Beshears E, Alvey N, Sauer A, Lieber R, Olaitan O, Hollinger E, Jensik S, Geyston J, Brokhof M, Hodowanec A, Simon D, Hertl M. Low Dose Valganciclovir Is an Effective Prophylaxis Against Cytomegalovirus in High Risk (Donor+/ Recipient-) Kidney Transplants Recipients [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/low-dose-valganciclovir-is-an-effective-prophylaxis-against-cytomegalovirus-in-high-risk-donor-recipient-kidney-transplants-recipients/. Accessed January 28, 2021.« Back to 2015 American Transplant Congress