1517. An International Survey of Cytomegalovirus Treatment Practices in Intestinal Transplantation
Session: Poster Abstract Session: Infections and Transplantation
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • An International Survey of Cytomegalovirus Treatment Practices in Intestinal Transplantation.pdf (169.2 kB)
  • Background:  Cytomegalovirus infections are associated with increased morbidity and mortality despite adequate antiviral treatment. Practice variation regarding cytomegalovirus treatment across intestinal transplantation programs is unknown.

    Methods:  An electronic survey regarding cytomegalovirus (CMV) treatment was sent to intestinal transplant programs registered with the Intestinal Transplant Association.  Proportions were analyzed for categorical variables; means and standard deviations were analyzed for continuous variables.

    Results:  Twenty-seven of the 35 active intestinal transplant programs (77%) responded to the survey.

    • For CMV viremia and syndrome, the reported first-line agents used were ganciclovir (n=26; 100%) and valganciclovir (n=6; 23.1%), while the reported second-line agents were foscarnet (n=19; 73.1%), cidofovir (n=4; 15.4%), valganciclovir (n=5; 19.2%) and ganciclovir (n=2; 7.7%).
    • For CMV tissue-invasive disease, the reported first-line agents were ganciclovir (n=25, 96.2%) or valganciclovir (n=2; 7.7%) and the reported second line agents were foscarnet (n-22, 84.6%), cidofovir (n=5; 19.2%), valganciclovir (n=2; 7.7%), and ganciclovir (n=1; 3.8%).
    • Intravenous immunoglobulins or CMV hyperimmune globulins were administered as adjunctive therapy in 65.4% (n=17) of the intestinal transplant programs for the following indications: CMV pneumonia (n=18; 69.2%), CMV meningo-encephalitis (n=13; 50%), CMV enteritis (n=12; 46.2%), CMV colitis (n=10; 38.5%), CMV syndrome (n=11; 42.3%), CMV viremia (n=8; 30.8%) and resistant or refractory CMV infections (n=3; 11.5%).
    • After completion of treatment for CMV viremia, syndrome and tissue-invasive disease, 73.1% (n=19) of the programs used secondary prophylaxis for a median of 4.5 months (range 1-12 months).

    Conclusion:  Treatment practices for patients with CMV viremia, syndrome and tissue-invasive disease are consistent across intestinal transplant programs and mainly involve the use of ganciclovir as first-line agent and foscarnet as second-line agent. The use of adjunctive immunoglobulins appears to be more common than in other allografts. Secondary prophylaxis was applied for extended length of time.

    Diana F. Florescu, MD1,2, Kareem Abu-Elmagd, MD3, David F. Mercer, MD2, Fang Qiu, PhD4 and Andre C. Kalil, MD, MPH5, (1)Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, (2)Transplant Surgery Division, University of Nebraska Medical Center, Omaha, NE, (3)Cleveland Clinic, Cleveland, OH, (4)Biostatistics Department, Nebraska Medical Center, Omaha, NE, (5)Internal Med., Univ. of Nebraska Med. Ctr., Omaha, NE


    D. F. Florescu, Behring: Consultant and Investigator, Consulting fee, Research grant and Research support
    Chimerix: Consultant and Grant Investigator, Consulting fee and Research grant

    K. Abu-Elmagd, None

    D. F. Mercer, None

    F. Qiu, Chimerix: Grant Investigator, Research support
    Behring: Grant Investigator, Research support

    A. C. Kalil, Chimerix: Grant Investigator, Research support

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.