title: Pharmacoepidemiology of cytomegalovirus prophylaxis in a large retrospective cohort of kidney transplant recipients with Medicare Part D coverage.
abstract: We assembled a cohort of 21 117 kidney transplant patients from July 2006 to June 2011 with Medicare Part D coverage using US Renal Database System data to determine real-world use of cytomegalovirus (CMV) prophylaxis. CMV prophylaxis was defined as filled prescriptions for daily oral valganciclovir (≤900 mg), ganciclovir (≤3 g), or valacyclovir (6-8 g) within 28 d of transplant. Multilevel logistic regression analyses were performed to determine factors associated with CMV prophylaxis. CMV prophylaxis (97% valganciclovir) was identified in 61% of kidney transplant recipients (median duration, 64 d); 71% of seronegative recipients of kidneys from seropositive donors (D+/R-); 63% of R+ patients; 60% of patients with unknown serostatus; and 34% of D-/R- patients. Variability in usage of prophylaxis among transplant centers was greater than variability within transplant centers. One in four transplant centers prescribed CMV prophylaxis to >60% of their D-/R- patients. CMV donor/recipient serostatus, lymphocyte-depleting agents for induction and mycophenolate for maintenance were associated with CMV prophylaxis. CMV prophylaxis was commonly used among kidney transplant recipients. Routine prescription of CMV prophylaxis to D-/R- patients may have occurred in some transplant centers. Limiting unnecessary use of CMV prophylaxis may decrease healthcare costs and drug-related harms.
authors: Section of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.
authors: Carlos A Q
authors: CA
authors: Santos
authors: Division of Renal Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
authors: Daniel C
authors: DC
authors: Brennan
authors: Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
authors: Mohammed J
authors: MJ
authors: Saeed
authors: Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
authors: Victoria J
authors: VJ
authors: Fraser
authors: Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.|Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
authors: Margaret A
authors: MA
authors: Olsen
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D054524:Medicare Part D; D008875:Middle Aged; D017891:Pharmacoepidemiology; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D066027:Transplant Recipients; D014481:United States / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents
keywords: cytomegalovirus; kidney transplant; pharmacoepidemiology