Valganciclovir prophylaxis extension from 3 to 6 months in high‐risk pancreas‐transplant recipients does not impact incidence of cytomegalovirus infection at 12 months. Issue 8 (13th June 2021)

• Record Type: Journal Article
• Authors: Jorgenson, Margaret R.; Marka, Nicholas; Leverson, Glen E.; Smith, Jeannina A.; Odorico, Jon S.
• Is Part Of: Clinical transplantation. Volume 35:Issue 8(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-06-13
• Subjects: graft survival -- infection and infectious agents -- patient survival -- preventive healthcare -- viral: Cytomegalovirus; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ctr.14379
• Languages: English
• ISSNs: 0902-0063

Abstract

Abstract: Problem: Incidence and impact of CMV infection in pancreas‐transplant recipients (PTRs) in the valganciclovir prophylaxis era has not been completely elucidated. Methods: Adult D+/R‐ PTRs were divided into a current era (1/1/2011‐12/31/17; 6‐month PPX) and a historic era (1/1/2003‐12/31/09; 3‐month PPX). Primary objective: effect of prophylaxis extension on the incidence of CMV infection. Secondary objective: impact of extension on valganciclovir‐related toxicity (leukopenia) and transplant outcomes. Results: There were 177 D+/R‐ PTRs in the study period (historic:98, current:79). Prophylaxis extension resulted in significant reduction of CMV infection from 25.4% to 10.9% at 6 months, (57% reduction, p = .021). However, 1‐year rates of CMV infection (historic:31% vs current:36%) and end‐organ disease (historic:7.7% vs current:6.9%) were not different ( p = .93). Prophylaxis extension significantly increased leukopenia (white blood cell count<3 K/uL) at 6 months (historic:9.5% vs current:28.6%, p = .018). On multivariable analysis prophylaxis extension was not associated with reduced rates of CMV infection ( p = .99) or CMV end‐organ disease ( p = .3). Additionally, there was no significant difference in rejection ( p = .2), graft survival ( p = .08), death‐censored graft survival( p = .07) or patient survival ( p = .6). Conclusions: Prophylaxis extension in D+/R‐ PTRs appears to delay time to first CMV but not reduce overall incidence. These findings suggest a hybrid approach, incorporating antiviral withdrawal and protocolized monitoring, may be needed to improve CMV‐related outcomes.