Reduced dosing versus full dosing valganciclovir for prophylaxis of cytomegalovirus in high-risk abdominal transplant recipients.

Abstract

Cytomegalovirus (CMV) is a common infection in abdominal transplant recipients (ATR). Prevention of CMV in the highest risk population (CMV IgG donor+/recipient-) is critical as CMV is associated with negative outcomes. Guideline recommended prophylactic valganciclovir dosing is 900mg daily for 6 months in this population. However, reduced dosing strategies are utilized in practice. This single center, retrospective study in adult ATR compared full valganciclovir prophylactic dosing (900mg daily for 6 months) to reduced dosing (900mg daily for 3 months, then 450mg daily for 3 months). The primary endpoint was incidence of CMV infection with viral load >1000 IU/mL. Secondary endpoints included incidence of CMV infection with viral load 200-1000 IU/mL, neutropenia, and leukopenia. Incidence of CMV infection with viral load >1000 IU/mL (29%vs. 27%, p=1) or CMV infection with viral load 200-1000 IU/mL (6%vs. 12%, p=.421) did not differ significantly between 68 ATR in reduced and full dosing groups, as well as incidence of leukopenia (94%vs. 97%, p=1) and neutropenia (77%vs. 70%, p=.586). There was no difference in the incidence of CMV infection, neutropenia, or leukopenia of the two dosing regimens, although time to CMV diagnosis was different.