Session Type: Poster Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Cytomegalovirus (CMV) is a common viral infection after kidney transplant (KT) despite prophylaxis with valganciclovir (VGCV). VGCV is renally dosed and can be a challenge among KT recipients (KTR) whose renal function can fluctuate post-transplant. We previously did a review of our data and noted frequent inappropriate VGCV dosing and high rates of CMV infection. Since 2017, our center eliminated VGCV half dosing in CMV R+ KTR and employed pharmacist monitoring of VGCV dosing. The objective of this study was to evaluate the efficacy of both interventions in pre- and post-intervention cohorts.
*Methods: A retrospective chart review was conducted of adult KTR who underwent KT between 3/2013-2/2015 pre-intervention and 6/2017-12/2018 post-intervention. KTR with multiorgan transplant or who died within the study period were excluded. The primary outcome was rate of CMV disease in CMV D+/R- and CMV R+ patients. Secondary outcomes included rate of overall CMV infection and appropriateness of VGCV dosing. Appropriateness of VGCV dosing was examined at hospital discharge and monthly for the duration of prophylaxis.
*Results: A total of 131 and 150 KTR were included in the pre- and post-intervention groups, respectively. Patients were similar at baseline with significantly more anti-thymoctye globulin induction and deceased donors pre-intervention and significantly more males, alemtuzumab induction and living donors post-intervention. Overall rates of CMV disease were similar, however there was a decrease in the CMV D+/R- patients. Improvement in appropriateness of VGCV dosing between groups was observed in CMV D+/R- patients at all time points and at discharge for CMV R+.
*Conclusions: Pharmacist monitoring of VGCV dosing after KT resulted in improved appropriateness of dosing, particularly in CMV D+/R-. Rates of CMV infection were similar among CMV R+, but the occurrence of CMV disease was lower in CMV D+/R- KTR post-intervention. This study demonstrated the value of transplant pharmacists in the implementation of a CMV prevention strategy in KTR.
To cite this abstract in AMA style:Belfield KD, Costello CE, Malinis M. The Value of Pharmacist-Driven Valganciclovir Dosing in Kidney Transplant Recipients in Reducing CMV Infection: A Single Center Experience [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/the-value-of-pharmacist-driven-valganciclovir-dosing-in-kidney-transplant-recipients-in-reducing-cmv-infection-a-single-center-experience/. Accessed December 1, 2023.
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