2387. Low-dose valganciclovir for CMV prophylaxis in intermediate-risk liver transplant recipients: a single center retrospective study
Session: Poster Abstract Session: Transplantation - Prophylaxis and Prediction
Saturday, October 7, 2017
Room: Poster Hall CD
Background: Liver transplant recipients (LTR) who are seropositive for CMV (R+) are at intermediate-risk for CMV disease. A preventive strategy following transplant is considered standard of care. Current guidelines recommend high-dose valganciclovir (VGCV) (900 mg/day adjusted for renal function) for prophylaxis given limited data on the efficacy and safety of low-dose VGCV (450 mg/day adjusted for renal function). We describe our experience with using low-dose VGCV prophylaxis in R+ LTR.

Methods: A database of 364 LTR from 2011-2014 was accessed. Patients with retransplants, liver-kidney transplants, HIV, or those in whom CMV serostatus or duration of VGCV exposure could not be confirmed were excluded. Low-dose VGCV was defined as 450 mg/day adjusted for renal function. Prophylaxis duration was 3 months; patients treated for rejection received an additional 3 months. The primary endpoint was CMV disease at one year post-transplant. Breakthrough CMV disease was defined as disease occurring while on VGCV prophylaxis. Secondary endpoints were rejection and leukopenia on VGCV. With respect to leukopenia, patients receiving low-dose VGCV were compared to a group of D+R- patients from the database receiving high-dose VGCV. Univariable analyses were performed using chi-squared, Fisher’s exact, or Wilcoxon rank-sum tests.

Results: 200 R+ LTR met inclusion criteria. Median age was 60 (interquartile range [IQR], 54–66) years, with 125 (64%) male, median MELD score of 23 (IQR, 14–31), and 178 (89%) patients receiving deceased-donor transplants. HCC, HCV, HBV, and alcoholic cirrhosis were the most common indications for transplant. CMV disease occurred in 9 (4.5%) patients. Two cases of breakthrough CMV disease occurred. No CMV resistance testing was performed. 18 (9%) patients had biopsy-proven rejection. Patients received VGCV prophylaxis for a median 3.4 (IQR, 3.1–4.3) months. 156 (76%) patients receiving low-dose VGCV developed leukopenia compared to 20 (80%) patients receiving high-dose VGCV (p=0.66). Premature VGCV discontinuation and G-CSF use were rare and not significantly different between the two groups.

Conclusion: Low-dose VGCV was effective at preventing CMV disease in R+ LTR. Few patients developed biopsy-proven rejection. Leukopenia was common on both low-and high-dose VGCV but rarely clinically significant.

Salman Khan, MD1, Timothy Sullivan, MD2, Mohsin Ali, MPhil1, Dallas Dunn, MD3, Gopi Patel, MD, MS4 and Shirish Huprikar, MD5, (1)Icahn School of Medicine at Mount Sinai, New York, NY, (2)Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, (3)Infectious Disease, Icahn School of Medicine at Mount Sinai, New York, NY, (4)Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, (5)Mount Sinai Hospital, New York, NY

Disclosures:

S. Khan, None

T. Sullivan, None

M. Ali, None

D. Dunn, None

G. Patel, None

S. Huprikar, None

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