Mp687successful Cost Effective Prevention of Cytomegalovirus Disease in Kidney Transplant Recipients Using Low Dose Valganciclovir

Gheith, Osama; Otaibi, Torki Al; Halim, Medhat A; Mansour, Hany A. A.; Mosaad, Ahmed; Attia, Hasanein; Elsayed, Zakaria; Said, Tarek; Nair, Prasad; Nampoory, Naryanan

doi:10.1093/ndt/gfw200.11

Cited by 6 publications

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“…There are multiple etiologies of leukopenia both before and after transplant in the LTR population, including host factors (age, cirrhosis), medication-induced myelosuppression (MMF, trimethoprim-sulfamethoxazole, VGCV) as well as CMV itself. (25) In univariate analyses, leukopenia was not associated with VGCV dose, recipient serostatus, or CMV disease, in contrast to other studies in organ transplant recipients (9,11) that found VGCV dose to be inversely proportional to WBC count.…”

Section: Discussionmentioning

confidence: 68%

“…A meta‐analysis of organ transplant recipients receiving low‐ versus high‐dose VGCV prophylaxis found no difference in efficacy and lower rates of rejection and leukopenia in the low‐dose group; however, only 239 LTRs were included in 3 of 20 studies. Recent studies comparing low‐ versus high‐dose VGCV prophylaxis in R+ renal transplant recipients (RTR) found no significant differences in CMV disease, rejection, or graft loss between the 2 groups and fewer episodes of leukopenia in the low‐dose group …”

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confidence: 99%

“…Recent studies comparing low-versus high-dose VGCV prophylaxis in R1 renal transplant recipients (RTR) found no significant differences in CMV disease, rejection, or graft loss between the 2 groups (10) and fewer episodes of leukopenia in the low-dose group. (11) There is a paucity of data on the use of low-dose VGCV in R1 LTRs. Park et al (12) retrospectively reviewed 45 R1 LTRs receiving low-dose VGCV prophylaxis; only 1 patient developed CMV disease up to 1 year after transplant.…”

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confidence: 99%

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Low‐dose valganciclovir for cytomegalovirus prophylaxis in intermediate‐risk liver transplantation recipients

Khan¹,

Sullivan²,

Ali

et al. 2018

Liver Transpl

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Liver transplantation recipients (LTRs) who are seropositive for cytomegalovirus (CMV) (recipient seropositive [R+]) are at intermediate risk for CMV disease. A preventative 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 using low-dose VGCV prophylaxis for R+ LTRs at our institution. A single-center, retrospective study was conducted using a database of 364 LTRs over a 4-year period (2011-2014). Adult first-time R+ LTRs receiving low-dose VGCV prophylaxis were included. The primary endpoint was CMV disease at 1 year after transplant. Patients were compared with historical controls receiving high-dose VGCV prophylaxis. Secondary endpoints were biopsy-proven rejection and leukopenia on VGCV. With respect to leukopenia, patients receiving low-dose VGCV were compared with a group of D+R- patients from the database receiving high-dose VGCV. Univariate analyses were performed using chi-squared, Fisher's exact, and Wilcoxon rank sum tests. A total of 200 R+ LTRs met inclusion criteria. Median age was 60 years (interquartile range [IQR], 54-66 years), and 129 (65%) LTRs were male. Median Model for End-Stage Liver Disease score was 22 (IQR, 14-31), and 178 (89%) patients received deceased donor transplants. CMV disease occurred in only 9 (5%) patients, similar to rates in previous studies of LTRs receiving high-dose VGCV. Biopsy-proven rejection occurred in 18 (9%) patients. Patients received VGCV prophylaxis for a median of 3.4 (IQR, 3.1-4.3) months; 151 (76%) R+ LTRs receiving low-dose VGCV developed leukopenia. Premature VGCV discontinuation and granulocyte-colony stimulating factor use were infrequent and not significantly different between the 2 groups. In conclusion, low-dose VGCV was safe and effective for prevention of CMV disease in our cohort of 200 R+ LTR and should be considered as an option in future guidelines. Liver Transplantation 24 616-622 2018 AASLD.

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confidence: 68%

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confidence: 99%

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confidence: 99%

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Low‐dose valganciclovir for cytomegalovirus prophylaxis in intermediate‐risk liver transplantation recipients

Khan¹,

Sullivan²,

Ali

et al. 2018

Liver Transpl

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“…We identified 24 studies including 2851 patients. Seventeen studies (11 RCTs15 24–38 and six single-arm39–46) with 1952 subjects focused on CMV prophylaxis and seven studies (5 RCTs17 19 47–49 and 2 single-arm43 44) with 899 subjects focused on IFI prophylaxis.…”

Section: Resultsmentioning

confidence: 99%

Exploring failure of antimicrobial prophylaxis and pre-emptive therapy for transplant recipients: a systematic review

et al. 2020

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Acknowledgements The authors would like to thank Mariska M.G. Leeflang for her suggestions and help while analyzing and compiling the data of this systematic review.Contributors AGM did the screening, writing, data analysis, risk of bias analysis, searches and planning; MB did the screening, searches, data analysis, writing; HB, EAMV, SPB, LFRS and TSvdW did the planning, writing, reviewing of manuscript; JWA did the writing, analysis and planning.

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“…Dose modification should be performed according to glomerular filtration rate (GFR) 5,6 . There are studies reporting increased risk of leukopenia and rejection with high dose (900 mg/g) valganciclovir prophylaxis [7][8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

Renal transplant alıcılarında düşük doz valgansiklovir profilaksisinin etkinliği ve güvenilirliği

Sayilar¹,

Ergun²

2020

Cukurova Medical Journal

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Öz Purpose: Cytomegalovirus (CMV) infection is one of the most common infections observed following kidney transplantations. Transplantations between cytomegalovirus (Immunoglobulin G)-seropositive donor and CMV-seropositive recipient (D+/R+) are considered to be of moderate risk. In our study, we investigated the efficacy of low-dose (450 mg/g) valganciclovir in CMV chemoprophylaxis in renal transplant patients over their first post-transplant year. Materials and Methods: A total of 68 consecutive patients aged over 18 years who underwent renal transplantation between January 2016 and June 2019 were included in this retrospective study. All patients were administered valganciclovir 450 mg/g, for 100 days. The efficacy of low-dose valganciclovir was determined by whether the patients developed a CMV disease during their first post-transplant year. Results: Only one patient (n=1/68) (1.5%) developed CMV disease. CMV DNA titer was positive on posttransplant day 134 of the patient who had unexplained loss of GFR. CMV disease-related acute rejection, graft loss, leukopenia, post-transplant diabetes mellitus, opportunistic infection, or patient loss was not observed. Conclusion: There are many studies comparing CMV prophylaxis with low and standard dose (450 vs. 900 mg/g) valganciclovir treatment in transplant patients. The results of this study show that low-dose valganciclovir is sufficient for the prophylaxis of CMV disease in D+/R+ mediumrisk patients without leading to any side effects. Further clinical studies with larger patient participation are needed. Amaç: Sitomegalovirüs (CMV) infeksiyonu, böbrek nakli sonrasında en sık görülen infeksiyonlardan biridir. Sitomegalovirüs (Immunglogulin G)-seropozitif donör ve CMV-seropozitif alıcı (D+/A+) arasında yapılan nakiller orta riskli kabul edilmektedir. Çalışmamızda renal transplantasyon yapılmış hastalarda nakil sonrası 1 yıllık dönem için düşük doz (450 mg/g) valgansiklovirin CMV kemoprofilaksindeki etkinliğini araştırdık. Gereç ve Yöntem: Ocak 2016 ile Haziran 2019 tarihleri arasında böbrek nakli yapılmış 18 yaş üzerinde ardışık 68 hasta retrospektif olarak çalışmaya dahil edildi. Tüm hastalara 100 gün süreyle 450 mg/g valgansiklovir tedavisi verildi. Düşük doz valgansiklovirin etkinliği hastaların posttransplant 1 yıl içerisinde CMV hastalığı geçirip geçirmemeleri dikkate alınarak belirlendi. Bulgular: Sadece bir hastada (n=1/68) (%1,5) CMV hastalığı gelişti. Nakil sonrası 134. günde nedeni açıklanamayan GFR kaybı olan hastanın CMV DNA titresi pozitif geldi. Tüm grupta CMV hastalığı ilişkili akut rejeksiyon, graft kaybı, lökopeni, PTDM, fırsatçı infeksiyon veya hasta kaybı gelişmedi. Sonuç: Literatürde transplant hastalarında CMV profilaksisi için düşük doz (450 mg/g) valgansiklovir tedavisinin standart doz (900 mg/g) ile karşılaştıran çok sayıda araştırma mevcuttur. Çalışmamızda düşük doz valgansiklovirin D+/A+ orta riskli hastalarda CMV hastalığının profilaksisi için yeterli olduğu ve yan etkiye yol açmadığını gördük. Bu konu ile ilgili geniş hasta katılımlı k...

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Mp687successful Cost Effective Prevention of Cytomegalovirus Disease in Kidney Transplant Recipients Using Low Dose Valganciclovir

Cited by 6 publications

References 0 publications

Low‐dose valganciclovir for cytomegalovirus prophylaxis in intermediate‐risk liver transplantation recipients

Low‐dose valganciclovir for cytomegalovirus prophylaxis in intermediate‐risk liver transplantation recipients

Exploring failure of antimicrobial prophylaxis and pre-emptive therapy for transplant recipients: a systematic review

Renal transplant alıcılarında düşük doz valgansiklovir profilaksisinin etkinliği ve güvenilirliği

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