1675. Comparison of virologic response and nephrotoxicity of 2 Cidofovir dosing regimens for pre-emptive treatment of Adenovirus infection in pediatric liver/multivisceral transplant recipients
Session: Poster Abstract Session: Pre-emptive Therapy in Transplantation and Immunocompromised Hosts
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDSA_poster_ADV_and_CDV final.pdf (200.8 kB)
  • Background:

    Adenovirus (ADV) is an important pathogen in solid organ transplant (SOT) recipients.  PCR has enabled early detection of ADV in SOT recipients. Treatment with Cidofovir (CDV) dosing regimen at 1 mg/kg/dose 3 times a week (Regimen B) to decrease nephrotoxicity has been advocated instead of the 5 mg/kg weekly for 2 weeks then every other week (Regimen A).  We aimed to compare virologic response to therapy (VR) and nephrotoxicity between these two regimens in SOT recipients.

    Methods:

    A 6-year retrospective study was conducted to collect viral load in log10 copies/mL (VL), regimen used, Bun/Cr from recipients with positive ADV PCR.  VR as measured by time to clearance (TTC) and decline in VL per week of therapy was analyzed using Kaplan-Meier survival estimates and T-test was used to compare the fold change in BUN/Cr from baseline to end of therapy (B-EOT) for each regimen. 

    Results:

    21 patients had 23 episodes of ADV infection during our study period.  Regimen A was used in 14 vs. Regimen B in 6 episodes.  Average VL at detection was 3.51.  The most common clinical presentation was gastroenteritis (30.4%) followed by febrile illness (21.7%).  There were 2 ADV-associated deaths, with VL at detection ≤ 3.57.

    Mean time to clearance was 27.87 days SEM 9.95 in Regimen A vs. 13.25 days SEM 5.00 with Regimen B.  Log-rank test showed no statistical difference in TTC between the regimens (p=0.273).  Linear mixed model analysis estimated a mean decrease in VL per week of -0.175 with Regimen A vs. -0.254 with Regimen B (p=0.3514).  Results of nephrotoxicity assessment are depicted in the following table:

     

     

    n

    Mean

    SD

    p-value

    BUN Maximum fold increase

     

     

     

     

    Regimen A

    12

    1.77

    1.32

    0.701

    Regimen B

    4

    2.06

    1.17

     

     

     

     

     

     

    Cr Maximum fold increase

     

     

     

     

    Regimen A

    12

    1.46

    0.82

    0.453

    Regimen B

    4

    1.27

    0.16

     

     

     

     

     

     

    Fold increase of BUN B-EOT

     

     

     

     

    Regimen A

    9

    1.70

    2.57

    0.666

    Regimen B

    4

    1.31

    0.41

     

     

     

     

     

     

    Fold increase of Cr B-EOT

     

     

     

     

    Regimen A

    9

    1.094

    0.408

    0.871

    Regimen B

    4

    1.055

    0.357

     

     

     

     

     

     

    Conclusion:

    VL had no predictive value for severity of disease. Based on the results, we found no difference in the VR between the two regimens.  Although not all potential confounders were controlled, we did not identify any significant difference in nephrotoxicity rates.

    Carlos Guerra-Sanchez, MD1, Cherish Lorica, MD1, Kristopher L. Arheart, EdD2, Michelle Perez, PharmD3 and Ivan Gonzalez, MD4, (1)Pediatrics, Division of Immunology and Infectious Diseases, University of Miami Miller School of Medicine/Jackson Health System, Miami, FL, (2)Department of Epidemiology & Public Health, University of Miami- Miller School of Medicine, Miami, FL, (3)Holtz Children's Hospital, Jackson Health System, Miami, FL, (4)Department of Pediatrics - Infectious Diseases, Univ. of Miami - Miller School of Medicine, Miami, FL

    Disclosures:

    C. Guerra-Sanchez, None

    C. Lorica, None

    K. L. Arheart, None

    M. Perez, None

    I. Gonzalez, None

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