Individualized management of cytomegalovirus in solid organ transplant recipients

Saeed, Huma; Thoendel, Matthew; Razonable, Raymund R.

doi:10.1080/23808993.2021.1964951

Cited by 2 publications

(3 citation statements)

References 104 publications

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“…If letermovir is not a viable option due to insurance limitations or cost, we typically discourage PEM conversion in the first 3 months in the high-risk population, due to the negative impact rapidly progressive replication would have during this period of highest intensity of immunosuppression. 37 If PEM conversion is pursued in a high-risk patient due to leukopenia, we will attempt to obtain maribavir for preemptive treatment over VGC, to avoid recurrent myelosuppression associated with VGC at treatment doses. Off-label maribavir is less challenging to obtain in the current state.…”

Section: Pemmentioning

confidence: 99%

“…If all recourse through a patient's insurance fails, or coverage results in a copay that is a financial burden to the patient and the patient does not fall below 500% of the Federal Poverty limit, the patient will not qualify for manufacturer patient assistance and unfortunately, will not be able to obtain letermovir. If letermovir is not a viable option due to insurance limitations or cost, we typically discourage PEM conversion in the first 3 months in the high‐risk population, due to the negative impact rapidly progressive replication would have during this period of highest intensity of immunosuppression 37 . If PEM conversion is pursued in a high‐risk patient due to leukopenia, we will attempt to obtain maribavir for preemptive treatment over VGC, to avoid recurrent myelosuppression associated with VGC at treatment doses.…”

Section: Background and Introductionmentioning

confidence: 99%

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Cytomegalovirus antiviral stewardship in solid organ transplant recipients: A new gold standard

Jorgenson

Descourouez

Kleiboeker

et al. 2022

Transplant Infectious Dis

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Purpose Antimicrobial stewardship programs (ASPs) are essential entities that promote the appropriate use of antimicrobials, leading to improved patient outcomes and reduced resistance. Application to the immunocompromised host is a natural progression for expansion. Cytomegalovirus (CMV) infection is a common complication following solid organ transplant with significant implications on graft survival, making it an attractive ASP target. The aim of this piece is to review our center‐specific experience with the development, implementation, and maintenance of a CMV stewardship initiative at a large transplant center. Methods Our CMV stewardship initiative began in 2018. Herein, we review 3 years’ experience and quality‐related improvement that occurred from initiation to present state and share our stewardship algorithms. Special attention is paid to the impact of the program as well as our increased understanding of the complex interplay between prevention, treatment, and host development of CMV‐specific cell‐mediated immunity (CMI). Results We found our stewardship initiative not only reduced the incidence of ganciclovir resistance but also streamlined care via a centralized and structured approach. This objective, protocolized program has resulted in a significant shift away from a reactive to a proactive state and in turn, reduced CMV treatment rates (26% at initiation to 12% in the current state, p = .012). Conclusion A dedicated multidisciplinary team focused on CMV stewardship is imperative in providing a patient‐centered approach focused on development of CMV‐specific CMI, and as a result prevention of CMV disease. We believe these programs will be the new gold standard for CMV management.

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Section: Pemmentioning

confidence: 99%

Section: Background and Introductionmentioning

confidence: 99%

Cytomegalovirus antiviral stewardship in solid organ transplant recipients: A new gold standard

Jorgenson

Descourouez

Kleiboeker

et al. 2022

Transplant Infectious Dis

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“…Cytomegalovirus (CMV) infection and disease following solid organ transplant (SOT) or hematopoietic stem cell transplant (HSCT) are common complications that may threaten transplant viability and increase the risk of mortality and morbidity [ 1 , 2 ]. CMV infection may occur due to transmission from the transplanted organ, reactivation of a latent infection, or after a primary infection in seronegative patients [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

A time trade-off study to determine health-state utilities of transplant recipients with refractory cytomegalovirus infection with or without resistance

Ahmed,

Longworth,

Oluboyede

et al. 2024

Health Qual Life Outcomes

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Background Health-state utility values (HSUVs) for post-transplant refractory cytomegalovirus (CMV) infection (with or without resistance [R/R]) were determined using a time trade-off (TTO) survey completed by 1,020 members of the UK general public. Methods Existing literature and qualitative interviews with clinicians experienced in treating R/R CMV were used to develop initial draft vignettes of health states. The vignettes were refined to describe three clinical states of R/R CMV: clinically significant and symptomatic (CS-symptomatic CMV); clinically significant and asymptomatic (CS-asymptomatic CMV); and non-clinically significant (non-CS CMV). Each clinical state was valued independently and combined with three events of interest: graft-versus-host disease; kidney graft loss; and lung graft loss to generate twelve vignettes. The final vignettes were evaluated by a sample of the UK general public using an online TTO survey. Exclusion criteria were applied to the final data to ensure that responses included in the analysis met pre-defined quality control criteria. Results Overall, 738 participants met the inclusion criteria and were included in the analysis. The sample was representative of the UK general population in terms of age and sex. Non-CS CMV had the highest mean HSUV (95% confidence interval) (0.815 [0.791, 0.839]), followed by CS-asymptomatic CMV (0.635 [0.602, 0.669]), and CS-symptomatic CMV (0.443 [0.404, 0.482]). CS-symptomatic CMV with lung graft loss had the lowest mean HSUV (0.289), with none of the health states considered on average worse than dead. Conclusions Post transplant R/R CMV has substantial impact on the health-related quality of life of patients. The utility values obtained in this study may be used to support economic evaluations of therapies for R/R CMV infection.

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Individualized management of cytomegalovirus in solid organ transplant recipients

Cited by 2 publications

References 104 publications

Cytomegalovirus antiviral stewardship in solid organ transplant recipients: A new gold standard

Cytomegalovirus antiviral stewardship in solid organ transplant recipients: A new gold standard

A time trade-off study to determine health-state utilities of transplant recipients with refractory cytomegalovirus infection with or without resistance

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