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.
|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)|
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 June 14, 2021.
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