Risk Factors for the Development of CMV Viremia in a Cohort of Morbidly Obese Kidney Transplant Recipients Under Low Dose Valganciclovir Prophylaxis.
1Pharmacy Practice, Univ of IL-Chicago Medical Center, Chicago, IL
2Dept of Surgery, Univ of IL-Chicago Medical Center, Chicago, IL.
Meeting: 2016 American Transplant Congress
Abstract number: C286
Keywords: Cytomeglovirus, Kidney transplantation, Obesity, Risk factors
Session Information
Date: Monday, June 13, 2016
Session Name: Poster Session C: Viruses and SOT
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Background: The rate of Cytomegalovirus infections in kidney transplant recipients drastically diminished with the advent of oral ganciclovir and subsequently valganciclovir. However it continues to be one of the most prevalent and concerning opportunistic infections in the transplant recipient. Various dosing strategies have been studied and reported over the last 15 years. We previously reported an increased prevalence of CMV viremia in obese patients versus non-obese. We aimed to look at various risk factors for development of CMV in this population.
Methods: From Jan 2009 to April 2014 we identified 189 kidney transplants in patients with a BMI>35. These patients received our standard prophylaxis of valganciclovir 450mg daily (adjusted for GFR based on MDRD) started by POD7 and continued for 6 months after transplant for all patients except donor neg/recipient neg serostatus. CMV PCR was checked at 3, 6, 9 and 12 months after transplant or at any time of concern for CMV infection.
Results: 144 patients had full data to evaluate during the time period. The overall incidence of CMV viremia was 11.1%. There was no difference in incidence of CMV viremia based on tacrolimus dosing requirement, with the thought this would represent poor absorbers. Other variables are broken down in Table 1. The average GFR (MDRD) in the patient's who developed CMV was only 47.1ml/min/m2. The 1 year pt and graft survival in patients who developed CMV was still 100%.
| Variable (n=144) | CMV Viremia (n=16) | p value |
| Race | ||
| AA (85) | 15.3% | |
| C and H (57) | 3.5% | 0.02 vs AA |
| Induction | ||
| Basiliximab (39) | 5.1% | |
| Thymoglobulin (100) | 13% | 0.23 |
| Peri-op pheresis (33) | 24% | |
| No pheresis (107) | 6.5% | 0.008 |
| CNI | ||
| CSA (13) | 7.7% | |
| Tac (129) | 11.6% | ns |
| Serology | ||
| neg/neg | 0% | |
| neg/pos | 5.9% | |
| pos/neg | 30.7% | |
| pos/pos | 12.9% |
Conclusion: In a population of morbidly obese kidney transplant patients, AA race and use of peri-operative plasmapheresis were identified as risk factors for the development of CMV viremia. Further evaluation of adjustment of valganciclovir dosing for GFR and subsequent development of CMV viremia is underway.
CITATION INFORMATION: Thielke J, Jasiak N, Hilal N, Salah S, Benedetti E, West-Thielke P. Risk Factors for the Development of CMV Viremia in a Cohort of Morbidly Obese Kidney Transplant Recipients Under Low Dose Valganciclovir Prophylaxis. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Thielke J, Jasiak N, Hilal N, Salah S, Benedetti E, West-Thielke P. Risk Factors for the Development of CMV Viremia in a Cohort of Morbidly Obese Kidney Transplant Recipients Under Low Dose Valganciclovir Prophylaxis. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/risk-factors-for-the-development-of-cmv-viremia-in-a-cohort-of-morbidly-obese-kidney-transplant-recipients-under-low-dose-valganciclovir-prophylaxis/. Accessed March 19, 2019.« Back to 2016 American Transplant Congress