title: Extended Low-Dose Valganciclovir Is Effective Prophylaxis Against Cytomegalovirus in High-Risk Kidney Transplant Recipients With Near-Complete Eradication of Late-Onset Disease.
abstract: BACKGROUND
  Cytomegalovirus (CMV)-seronegative kidney transplant (KTx) recipients of organs from CMV-seropositive donors (D+/R-) are at increased risk for CMV infection. Despite valganciclovir (VGCV) prophylaxis (900 mg daily for 200 days), late-onset CMV (LO-CMV) occurs at excessive rates. VGCV-associated cost and toxicities remain problematic.
  
  
  METHODS
  We retrospectively evaluated 50 D+/R- adult KTx recipients from August 2008 to August 2014 who received low-dose VGCV (450 mg daily) prophylaxis for an extended duration. The primary outcome was occurrence of CMV disease.
  
  
  RESULTS
  All patients received depletion induction and underwent ABO-compatible KTx. Mean prophylaxis and follow-up durations were 22.8 and 40.7 months, respectively. Eight patients developed CMV: 5 breakthrough cases (1 case of colitis [2%] and 4 cases of infection [8%]) and 3 cases of LO-CMV (1 syndrome [2.9%] and 2 cases of infection [5.7%]). On logistic regression, longer duration of VGCV prophylaxis was protective against CMV infection or disease (P = .044; odds ratio, 1.12 [95% confidence interval, 1.03-1.29]). None of 19 recipients with prophylaxis for ≥12 months developed LO-CMV compared with 3 of 16 recipients with prophylaxis for <12 months (18.8%) (P = .086). Four patients had recurrence of CMV, and 1 patient developed resistance. CMV was not responsible for graft or patient loss and did not affect survival.
  
  
  CONCLUSIONS
  Low-dose VGCV is an effective prophylaxis for D+/R- KTx recipients despite depleting induction. Longer prophylaxis is more protective, and receiving VGCV for ≥12 months nearly eradicated LO-CMV without increasing antiviral resistance.
authors: Transplant Surgery, Fort Worth Transplant Institute, Plaza Medical Center, Fort Worth, Texas; Department of Surgery, Faculty of Medicine, Cairo University, Cairo Egypt; Rush University Medical Center, Chicago, Illinois, USA. Electronic address: sfayek@ppghealthcare.com.
authors: S A
authors: SA
authors: Fayek
authors: Rush University Medical Center, Chicago, Illinois, USA.
authors: E
authors: E
authors: Beshears
authors: Rush University Medical Center, Chicago, Illinois, USA.
authors: R
authors: R
authors: Lieber
authors: Rush University Medical Center, Chicago, Illinois, USA.
authors: N
authors: N
authors: Alvey
authors: Rush University Medical Center, Chicago, Illinois, USA.
authors: A
authors: A
authors: Sauer
authors: Rush University Medical Center, Chicago, Illinois, USA.
authors: J
authors: J
authors: Poirier
authors: Rush University Medical Center, Chicago, Illinois, USA.
authors: E F
authors: EF
authors: Hollinger
authors: Rush University Medical Center, Chicago, Illinois, USA.
authors: O K
authors: OK
authors: Olaitan
authors: Rush University Medical Center, Chicago, Illinois, USA.
authors: S
authors: S
authors: Jensik
authors: Rush University Medical Center, Chicago, Illinois, USA.
authors: J
authors: J
authors: Geyston
authors: Rush University Medical Center, Chicago, Illinois, USA.
authors: M M
authors: MM
authors: Brokhof
authors: Rush University Medical Center, Chicago, Illinois, USA.
authors: A C
authors: AC
authors: Hodowanec
authors: Rush University Medical Center, Chicago, Illinois, USA.
authors: M
authors: M
authors: Hertl
authors: Rush University Medical Center, Chicago, Illinois, USA.
authors: D M
authors: DM
authors: Simon
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000187:drug effects; D003586:Cytomegalovirus Infections / Q000517:prevention & control*; D003692:Delayed-Action Preparations; D024882:Drug Resistance, Viral; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D066027:Transplant Recipients; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D003692:Delayed-Action Preparations; D000077562:Valganciclovir; D015774:Ganciclovir