Viral Prophylaxis Is Unnecessary in CMV Low Risk Kidney Transplant Recipients Who Receive Lymphocyte Depleting Induction
1Pharmacy, University of Maryland, Baltimore
2Transplant, University of Utah, Salt Lake City
3Transplant, University of Southern California, Los Angeles.
Meeting: 2015 American Transplant Congress
Abstract number: A80
Keywords: Antilymphocyte antibodies, Cytomeglovirus, Kidney transplantation, Viral therapy
Session Information
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Exhibit Hall E
Background: Both the international CMV consensus and AST guidelines recommend against the routine use of CMV prophylaxis in CMV D-/R- kidney transplant recipients (KTR), but do support anti-herpes prophylaxis in this population. Specifically, AST guidelines recommend at least 1 month of anti-viral prophylaxis, irregardless of induction agent used. Our institution historically used acyclovir (ACV) 200 mg PO 5x/day x 1 month in this population, but later transitioned away from anti-viral prophylaxis completely in 2010. We aimed to assess the efficacy and compare the costs of this ACV regimen vs. no prophylaxis in our CMV D-/R- KTR, the majority of whom received lymphocyte-depleting induction.
Methods: This was a retrospective study of adult CMV D-/R- KTR transplanted between 1/2003-10/2013 who received either ACV or no anti-viral prophylaxis. We excluded KTR with graft loss/death within 30 days of transplant or who were lost to follow-up within 1 year of transplant. All outcomes were assessed at 1 year post-transplant and included the incidence of HSV, CMV, other opportunistic infections (OI), malignancy, rejection, patient and graft survival. A cost analysis was performed using average wholesale price (AWP) per Medi-Span®.
Results: 55 KTR were included (36 ACV vs. 19 no prophylaxis). Demographics and immunological risks were similar; of note 72.2% and 84.2% received lymphocyte-depleting induction in the ACV and no prophylaxis groups, respectively. There were no HSV infections in either group, nor was there a difference in patient or graft survival. Although there was a greater incidence of rejection and CMV infection in those without prophylaxis, the difference was not statistically significant. Total AWP of the ACV regimen is $146.55.
| ACV | No Prophylaxis | |
| # pts | 36 | 19 |
| Mean age (SD), yr | 40.2 (14.1) | 46.2 (16.6) |
| Male | 63.4% | 63.2% |
| White | 100% | 100% |
| DD | 38.9% | 36.8% |
| LD | 61.1% | 63.2% |
| PRA 0% | 94.4% | 84.2% |
| PRA > 20% | 5.6% | 5.3% |
| Lymphocyte-depleting induction | 72.2% | 84.2% |
| Maintenance FK/MPA | 63.9% | 15.8% |
| Maintenance FK/MPA/Pred | 19.4% | 84.2% |
| HSV | 0% | 0% |
| CMV | 5.6% | 10.5% |
| Other OI's | 8.3% | 5.3% |
| Malignancy | 0% | 0% |
| Rejection | 5.6% | 15.8% |
| Patient survival | 97.2% | 94.7% |
| Graft survival | 97.2% | 94.7% |
Conclusion: CMV D-/R- KTR induced with lymphocyte-depleting agents who did not receive anti-viral prophylaxis are not at an increased risk for herpes infection.
To cite this abstract in AMA style:
Gillespie M, Sirandas B, Carlson A, Lee S, Smith L. Viral Prophylaxis Is Unnecessary in CMV Low Risk Kidney Transplant Recipients Who Receive Lymphocyte Depleting Induction [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/viral-prophylaxis-is-unnecessary-in-cmv-low-risk-kidney-transplant-recipients-who-receive-lymphocyte-depleting-induction/. Accessed November 21, 2024.« Back to 2015 American Transplant Congress