Low‐dose valganciclovir prohylaxis is efficacious and safe in cytomegalovirus seropositive heart transplant recipients with anti‐thymocyte globulin

Abstract

The hybrid strategy with low-dose VGCV in R+ patients with ATG was efficient and safe. The good treatment results indicate that the regimen did not lead to a clinically relevant resistance. Optimal renal dosage is essential throughout prophylaxis.

Cytomegalovirus infection and allograft rejection among pediatric heart transplant recipients in the era of valganciclovir prophylaxis

“…We noted an overall incidence of CMV infection of 34% in our cohort during the study period, consistent with prior reports 6,16‐19 . Breakthrough CMV infection was seen in 10%‐14% of individuals while on VGC prophylaxis, with no notable difference between HR and IR cohorts, similar to previously reported studies 7 . However, median time to CMV infection following completion of VGC prophylaxis was noted to be significantly shorter among HR (D+/R−) recipients, at 212 days (32 days post‐prophylaxis), compared to 457 days (280 days post‐prophylaxis) among IR (R+) recipients.…”

“…However, median time to CMV infection following completion of VGC prophylaxis was noted to be significantly shorter among prophylaxis. 6,7 To account for the difference in time to infection following VGC prophylaxis among CMV risk cohorts, we considered a number of possibilities, including the role of CMV-specific CMI in preventing CMV infection and disease following SOT. [20][21][22] In a study of 95…”

“…prophylaxis, similar to a recent adult study evaluating low-dose VGC prophylaxis among HTx recipients. 7 contributed to CMV infection rates following prophylaxis. Similar to a previously reported study among pediatric renal transplant recipients, we noted higher breakthrough CMV infection with ATG.…”

“…While current guidelines outline describe a number of potential CMV management strategies following SOT including antiviral prophylaxis, preemptive therapy, and hybrid approaches, universal antiviral prophylaxis is recommended for HR CMV discordant (D+/R−) HTx recipients 2 . VGC, an oral prodrug of ganciclovir, is widely used following HTx and has been shown to decrease CMV infection and disease among adult HTx recipients 6‐9 . Yet few studies to date have explored the burden of CMV infection among pediatric HTx recipients in the setting of VGC prophylaxis 1,10‐12 …”

Impact of valganciclovir prophylaxis duration on cytomegalovirus disease in high‐risk donor seropositive/recipient seronegative heart transplant recipients

“…Additionally, the presence of confounding by indication was assessed by inverse propensity weighting analysis. The observed overall incidence of proven/probable CMV disease in our D+R− HTR cohort, 5.2% (3/58) at 6 months and 17.2% (10/58) at 1 year, was similar to previously published cohorts receiving 3 or 6 months of prophylaxis and provides some reassurance of the generalizability of results to other heart transplant populations (10.5% [10/95] pooled 6‐month CMV disease incidence, 21.2% [41/193] pooled 1‐year CMV disease incidence, studies summarized in Table S2). We acknowledge that the size of our cohort limited the difference in CMV disease that could be detected between the 3‐month vs 6‐month groups; however, the number of patients in this study was still relatively large in comparison to prior studies focused on D+R− HTR, and we did not observe even a trend toward benefit of a longer duration of prophylaxis.…”