1666. Results of Post Cytomegalovirus Prophylaxis Surveillance in High Risk Lung and Heart 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
  • CMV Poster_Sep27-2013- IDSA.pdf (259.9 kB)
  • Background: Late onset cytomegalovirus (CMV) disease is a major cause of morbidity in CMV primary mismatch donor positive / recipient negative (D+/R-) solid organ transplant recipients. An optimal monitoring strategy following the cessation of prophylaxis might result in early detection of CMV infection and abrogate progression to CMV disease while reducing hospital admission rates for treatment.

    Methods: A single center retrospective review of consecutive D+/R- heart and lung transplant recipients (HTLR) from January 2010 to March 2012 with 1 year post transplant follow-up. Valganciclovir was given at 900 mg for a minimum of 6 months as per CMV prophylaxis protocol. CMV PCR was monitored weekly for 4 weeks then biweekly for the following 8 weeks; preemptive CMV treatment was initiated at a predefined end point. CMV infection and disease were defined as per AST criteria.

     

    Results:

     

    Outcome

    Total D+/R- LHTR

    N =48

    Lung Transplant Cohort

    N = 37

    Heart Transplant Cohort

    N = 11

    Patient Number (%)

    Patient Number (%)

    Patient Number (%)

    CMV Disease

    21 (44)

    14 (37)

    7 (64)

    CMV Infection

    17 (35)

    16 (43)

    1 (9)

    Hospitalizations Due to CMV

    14 (29)

    8 (22)

    6 (55)

    Compliance to Protocol

    16 (33)

    15 (40)

    1 (9)

    Compliance & CMV Disease

    8 (50)

    7 (46)

    1

    Median time to disease onset was 73.5 (IQR 34 - 196) days post prophylaxis cessation. None of the patients treated for CMV infection progressed to disease. Acute rejection was significantly associated with CMV disease development (15 LHTRs prior to CMV disease) [OR 4.69 95% CI (1.07 20.19), P = 0.04]. Twenty one percent (10 / 48) remained CMV free during a 6 months follow up period post cessation of prophylaxis.

     

    Conclusion: Late onset CMV disease developed in 44% of D+/R- LHTR after 6 months of prophylaxis. Adjustments to surveillance timing and duration are required, particularly following an episode of acute rejection. Pre-emptive treatment was successful in preventing CMV disease in one third of the cohort.

    Sarah Shalhoub1, Coleman Rotstein, MD1, Lianne Singer, MD2, Heather Ross2 and Shahid Husain, MD, MS1, (1)University of Toronto, Toronto, ON, Canada, (2)University Health Network, Toronto, ON, Canada

    Disclosures:

    S. Shalhoub, None

    C. Rotstein, Astellas, Merck and Pfizer: Grant Investigator and Speaker's Bureau, Research grant and Speaker honorarium

    L. Singer, None

    H. Ross, None

    S. Husain, Astellas, Merck and Pfizer: Grant Investigator, Research grant

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