(983) - Impact of Prolonging CMV Prophylaxis in High Risk (CMV D+/R-) Lung Transplant Recipients

Abstract

Purpose Cytomegalovirus (CMV) seronegative recipients receiving a seropositive allograft (D+/R-) are at a high risk of developing CMV disease. Our program increased the duration of CMV prophylaxis from 6 to 9 months in May 2013. Here, we present the impact on the incidence of CMV infection, disease, side effects and other factors. Methods Retrospective cohort of 241 CMV (D+/R-) transplanted from January 1, 2008 to December 31, 2017. Blood CMV testing was done according to protocol. All patients received ganciclovir/valganciclovir as prophylaxis. We recorded the incidence and timing of CMV infection and disease up to 6 months after cessation of prophylaxis. CMV infection was defined as detectable CMV-viremia in the absence of symptoms. CMV disease was defined as CMV syndrome or tissue-invasive disease. Side effects of prophylaxis were recorded. Results 9-month prophylaxis both delayed and decreased the rate of CMV disease (Figure 1) with no difference in the rate of CMV infection (Figure 1). The rate of biopsy-proven acute cellular rejection was lower in the extended 9 month prophylaxis group, although not statistically significant (Table 1). There was no difference in the rate of adverse effects or development of CMV resistance between the two groups. Conclusion Extending duration of CMV-prophylaxis from 6 to 9 months resulted in a delayed and decreased incidence of CMV disease in our lung transplant population. The incidence of CMV infection, and ganciclovir resistance and side effects were similar between the two groups. Our results suggest that extending CMV prophylaxis in the highest risk CMV D+/R- group is effective in reducing CMV-disease.