Methods: Medical records of adult patients who underwent kidney transplant from 6/1/2013 - 1/31/2015 and received CMV prophylaxis with valganciclovir were reviewed 1-year post-transplant. Cases were patients who developed viremia after initiation of CMV prophylaxis. Controls were patients who did not develop viremia. Cases were matched to controls on a 1:2 basis. Exclusion criteria: history of prior organ transplant, en bloc or multi-organ transplant; use of anti-CMV therapy within 30 days prior to study; graft loss within 1 month.
Results: 220/418 transplant recipients met eligibility criteria. Case and controls were well matched, except D+/R- were more likely to develop CMV viremia. Suboptimal dosing of valganciclovir was not statistically different, with 18% in each group receiving suboptimal dosing (p=0.977). There was no difference in graft loss or rejection rates (p=0.695). Patients who developed CMV viremia were more likely to have stopped prophylaxis due to neutropenia (31.8% vs. 12.6%, p=0.008). Mean time from stopping prophylaxis secondary to neutropenia and time to event was 64 days. D+ or D-/R+ patients who developed viremia were more likely to stop prophylaxis due to neutropenia (25% vs. 8.3%, p=0.026).
Conclusion: No differences exist in suboptimal dosing of CMV prophylaxis between cases and controls. Patients who stopped prophylaxis early due to neutropenia were more likely to develop CMV viremia, and would not have been on prophylaxis at time of event. There was no difference in graft rejection rates or non-CMV outcomes when risk-stratifying patients based on CMV serostatus. The group of patients who undergo early discontinuation of prophylaxis for neutropenia are candidates for enhanced surveillance.
R. Avery, None
L. Pote, None
J. Smith, None
N. Ejaz, None
K. Dzintars, None