Anti-thymocyte globulin (ATG) treatment for acute T-cell mediated rejection (TCMR) can increase the risk of CMV infection. We purposed to evaluate the effect of valacyclovir prophylaxis against CMV infection after ATG administration as anti-rejection therapy.

We retrospectively analyzed 55 kidney transplant recipients (KTR) receiving ATG for steroid resistant TCMR. In 55 KTRs, we used intravenous ganciclovir during ATG injection. In 34 KTRs treated , we did preemptive therapy for CMV infection after ATG therapy. They were regarded as History control group (CONT). Since July 2013, we used valacyclovir prophylaxis for 1 month after ATG therapy in 21 patients, who belonged to valacyclovir group (VAL). The primary outcome was the incidence of CMV infection and the secondary outcomes were subsequent acute rejection, graft and patient outcome.

Valacyclovir prophylaxis significantly reduced the incidence of CMV infection (VAL 9.8% Vs CONT 67.6%, p<0.001) and CMV-free survival rate was higher in VAL group compared to CONT group as well. (p=0.009). There was no difference of graft failure (CONT 70.5% Vs VAL 47.6%, p=0.152), incidence of subsequent rejection after ATG treatment (CONT 41.4% Vs VAL 33.3%, p>0.776), and graft or patient survival. There were no major adverse events associated with valacyclovir prophylaxis.

In conclusion, valacyclovir prophylaxis is effective for the prevention of CMV infection after ATG treatment for steroid resistant TCMR.

CITATION INFORMATION: Ko E, Yu J, Choi B, Park C, Kim Y, Yang C, Chung B. Usefulness of Valacyclovir Prophylaxis for Preventing Cytomegalovirus Infection After Anti-Thymocyte Globulin Treatment as Antirejection Therapy. Am J Transplant. 2017;17 (suppl 3).

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