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.
|Mean age (SD), yr||40.2 (14.1)||46.2 (16.6)|
|PRA > 20%||5.6%||5.3%|
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 29, 2020.
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