2293. Valganciclovir Dosing in Kidney Transplant Recipients for the Prevention of Cytomegalovirus (CMV) Viremia
Session: Poster Abstract Session: Transplants: CMV and Transplantation
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • S. Shulder ID week CMV poster final.pdf (345.9 kB)
  • Background: CMV remains a common viral infection affecting kidney transplant recipients. Donor/recipient serostatus is a key predictor of CMV infection post-transplant. Kidney recipients receive antiviral prophylaxis based on serostatus and level of risk. Antiviral dosing is complicated due to rapidly changing renal function post-transplant. Suboptimal dosing can lead to reduced efficacy and CMV viremia. This study assessed the appropriateness of antiviral dosing for CMV prophylaxis in kidney recipients.

    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.

    Stephanie Shulder, PharmD1, Seema Mehta, MD, MS2, Robin Avery, MD, FIDSA2, Lindsey Pote, PharmD1, Janessa Smith, PharmD1, Nicole Ejaz, PharmD1 and Kathryn Dzintars, PharmD1, (1)Department of Pharmacy, The Johns Hopkins Hospital, Baltimore, MD, (2)Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD

    Disclosures:

    S. Shulder, None

    S. Mehta, None

    R. Avery, None

    L. Pote, None

    J. Smith, None

    N. Ejaz, None

    K. Dzintars, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.