Valganciclovir prophylaxis extension from 3 to 6 months in high-risk pancreas-transplant recipients does not impact incidence of cytomegalovirus infection at 12 months.

Abstract

Incidence and impact of CMV infection in pancreas-transplant recipients (PTRs) in the valganciclovir prophylaxis era has not been completely elucidated. Adult D+/R- PTRs were divided into a current era (1/1/2011-12/31/17; 6-month PPX) and a historic era (1/1/2003-12/31/09; 3-month PPX). effect of prophylaxis extension on the incidence of CMV infection. impact of extension on valganciclovir-related toxicity (leukopenia) and transplant outcomes. There were 177 D+/R- PTRs in the study period (historic:98, current:79). Prophylaxis extension resulted in significant reduction of CMV infection from 25.4% to 10.9% at 6months, (57% reduction, p=.021). However, 1-year rates of CMV infection (historic:31% vs current:36%) and end-organ disease (historic:7.7% vs current:6.9%) were not different (p=.93). Prophylaxis extension significantly increased leukopenia (white blood cell count<3K/uL) at 6months (historic:9.5% vs current:28.6%, p=.018). On multivariable analysis prophylaxis extension was not associated with reduced rates of CMV infection (p=.99) or CMV end-organ disease (p=.3). Additionally, there was no significant difference in rejection (p=.2), graft survival (p=.08), death-censored graft survival(p=.07) or patient survival (p=.6). Prophylaxis extension in D+/R- PTRs appears to delay time to first CMV but not reduce overall incidence. These findings suggest a hybrid approach, incorporating antiviral withdrawal and protocolized monitoring, may be needed to improve CMV-related outcomes.