Valganciclovir Prophylaxis is Not Associated with Polyomavirus Viremia after Renal Transplantation

D. Conti¹, D. Schuster¹, M. Garner¹, E. Maciera¹, S. Patel²

¹Albany Medical Center, Albany, NY, ²Surgery, Albany Medical Center, Albany, NY

Meeting: 2020 American Transplant Congress

Abstract number: D-179

Keywords: Ganciclovir, Infection, Kidney transplantation, Polyma virus

Session Information

Session Name: Poster Session D: Kidney: Polyoma

Session Type: Poster Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: Recent studies have implicated prophylactic valganciclovir (VGC) therapy after renal transplantation to be associated with an increased rate of BK polyomavirus viremia and nephropathy. We reviewed our BK-viremia (BKV) and nephropathy rates over a 6-year experience using VGC prophylaxis in recipients at risk for cytomegalovirus (CMV) disease (donor CMV+/recipient CMV-, or recipient CMV+) compared to recipients who were not treated with VCG (donor CMV-/recipient CMV-).

*Methods: Between Jan. 1, 2013 and Dec. 31, 2018, 314 renal transplants were performed at our institution. In 312 of these patients monthly plasma screening by PCR for BKV was performed. BKV was defined by at least two positive plasma values of more than 1,000 copies/mL. BK nephropathy (PVAN) was defined by biopsy for cause. Sixty-three (20%) of these patients were at risk for primary CMV disease (D+/R-) and were treated with VGC for 180 days after transplant (Group A). 124 recipients (40%) were CMV+ and received prophylactic VGC for the first 90 days after transplant (Group B). 125 patients were in the D-/R- category and were not treated with VGC (Group C). Immunosuppression for all three groups consisted of induction therapy with Thymoglobulin followed by maintenance triple therapy.

*Results: Overall, BKV developed in 60 of the 312 recipients (19%). BKV was identified in 11/63 (17%) Group A (D+/R-) recipients who received 180 days of prophylactic VGC. In Group B patients (R+) treated with prophylactic VGC for 90 days, 20/124 recipients developed BKV (16%). Of the 125 Group C patients who did not receive prophylactic VGC 29 (23%) were identified to have BKV. The combined rate of BKV in patients treated with prophylactic VGC (Groups A+B) was 17% (31/187), versus 23% in non VGC treated recipients. The mean time to the development of BKV after transplant was 5 months in Group A, 4 months in Group B and 5 months in Group C patients. PVAN developed in 3 Group A+B patients (1.6%) and 2 Group C recipients (1.6%)

*Conclusions: The incidence and timing of the development of BKV and rate of PVAN was not increased in renal transplant recipients who received VGC for the prevention of post-transplant CMV disease. Prophylactic VGC is not associated with an increased rate of BKV and is not a risk factor for PVAN.

To cite this abstract in AMA style:

Conti D, Schuster D, Garner M, Maciera E, Patel S. Valganciclovir Prophylaxis is Not Associated with Polyomavirus Viremia after Renal Transplantation [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/valganciclovir-prophylaxis-is-not-associated-with-polyomavirus-viremia-after-renal-transplantation/. Accessed November 21, 2024.

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