A Retrospective Comparison of the Safety and Efficacy of 3 months vs. 6 months Valganciclovir for Cytomegalovirus Prophylaxis in Renal Transplant Recipients

Abstract

Abstract Background: Antiviral prophylaxis has been shown to be effective in reducing the risk of CMV disease in renal transplant recipients and reducing all-cause mortality in solid organ transplant recipients. Extending valganciclovir prophylaxis from 100 to 200 days was associated with a further reduction of CMV disease post-renal transplant. Longer valganciclovir prophylaxis can induce leukopenia, increase risk of other infections, and lead to alteration in immunosuppression, which may lead to rejection. It is currently unknown how the extension from 3 to 6-month prophylaxis with valganciclovir has impacted outcomes in our institution. Methods: A retrospective chart review was conducted from January 1st 2010 to May 31st 2014 (followed until May 31st 2015). Patients were included if they had received a renal transplant and were prescribed 3 months (group 1; from January 2010 to December 2011) or 6 months (group 2; from January 2012 to May 2014) of valganciclovir and were at least 18 years of age at time of transplant. Results: Both groups experienced high rates of leukopenia; 78% in 3-month prophylaxis group compared to 85% in 6-month prophylaxis group (P = 0.284). There is a statistically insignificant increase in patients who developed CMV viremia in 6-month prophylaxis group (19.8%) compared to the 3-month group (14.3%). There was one patient in 3-month prophylaxis group (2.0%) and three patients in 6-month prophylaxis group (3.5%) (P=0.633) who experienced acute rejection. Conclusion: The change of TOH Renal Transplant Protocol to extend duration of CMV prophylaxis from 3 to 6 months for high-risk recipients did not result in statistically significant change in incidence of leukopenia; CMV viremia; or rates of graft rejection.