Pharmacoepidemiology of Cytomegalovirus Prophylaxis in a Large Multicenter Cohort of Kidney Transplant Recipients
Washington University School of Medicine, Saint Louis, MO.
Meeting: 2015 American Transplant Congress
Abstract number: 334
Keywords: Multivariate analysis, Resource utilization
Session Information
Session Name: Concurrent Session: Viral Infections (CMV, HBV, HCV, HIV, Norovirus)
Session Type: Concurrent Session
Date: Monday, May 4, 2015
Session Time: 4:00pm-5:30pm
Presentation Time: 4:24pm-4:36pm
Location: Room 121-AB
Background: Cytomegalovirus (CMV) prophylaxis or preemptive treatment are recommended for seronegative recipients of kidneys from seropositive donors (D+/R-) and seropositive patients (R+), but not D-/R- patients. Real-world prescription of CMV prophylaxis for US kidney transplant recipients has never been examined using claims data.
Methods: To determine the utilization of CMV prophylaxis across transplant centers nationally, we assembled a cohort of 21,136 kidney transplant recipients from July 2006 through June 2011 with Medicare Part D coverage using US Renal Database System (USRDS) data and identified prescription of daily oral valganciclovir (≤ 900 mg), ganciclovir (≤ 3 g) or valacyclovir (6 g) ≤ 7 days after transplant hospitalization discharge. Multilevel logistic regression analysis with varying intercepts by transplant center was performed to determine independent factors associated with CMV prophylaxis.
Results: CMV prophylaxis (96% valganciclovir) was prescribed to 71% of kidney transplant recipients (median duration, 89 days); 83% of D+/R- patients; 74% of R+ patients; 60% of patients with unknown serostatus; and surprisingly 43% of D-/R- patients. Factors associated with CMV prophylaxis were D/R serostatus and anti-lymphocyte antibody for induction. Variability in prophylactic practices among transplant centers was greater than variability within transplant centers.
| All | D+/R- | R+ | Unknown | D-/R- | |
| Prophylaxis (%) | 15,086 (71.38) | 2,195 (83.40) | 10,797 (74.26) | 1,356 (60.32) | 738 (42.98) |
| Valganciclovir (%) | 14,546 (96.42) | 2,121 (96.63) | 10,383 (96.17) | 1,329 (98.01) | 713 (96.61) |
| Median duration in days | 89 | 90 | 88 | 94 | 85 |
| — Interquartile range in days | 55-129 | 39-171 | 56-121 | 59-169 | 30-117 |
| aOR (95% CI) | |
| Increasing age per decade | 0.90 (0.88-0.92) |
| Female sex | 1.12 (1.05-1.21) |
| Non-white race | 1.08 (1.00-1.17) |
| Cadaveric kidney transplant | 1.29 (1.17-1.42) |
| Anti-lymphocyte antibody for induction | 2.16 (1.98-2.35) |
| CMV D/R serostatus | |
| — D+/R- | 11.04 (9.40-12.96) |
| — R+ | 5.87 (5.19-6.64) |
| — Unknown | 3.02 (2.55-3.56) |
| — D-/R- | 1.00 |
Conclusions: CMV prophylaxis appears to be over-prescribed to D-/R- US kidney transplant recipients enrolled in Medicare Part D. CMV D/R serostatus and anti-lymphocyte antibody for induction are associated with the prescription of CMV prophylaxis. Decreasing overuse of CMV prophylaxis can decrease healthcare costs.
To cite this abstract in AMA style:
Santos C, Brennan D, Fraser V, Olsen M. Pharmacoepidemiology of Cytomegalovirus Prophylaxis in a Large Multicenter Cohort of Kidney Transplant Recipients [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/pharmacoepidemiology-of-cytomegalovirus-prophylaxis-in-a-large-multicenter-cohort-of-kidney-transplant-recipients/. Accessed November 21, 2024.« Back to 2015 American Transplant Congress