Abstract: FR-PO903
The Rate of Cytomegalovirus Infection and Disease in Renal Transplant Patients
Session Information
- Transplantation: Translational and Transplant Pathology
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Bibera, Mark allen T., UC Davis Medical Center, Sacramento, California, United States
- Alnimri, Muna, UC Davis Medical Center, Sacramento, California, United States
- Hao, Diana, UC Davis Medical Center, Sacramento, California, United States
- Le, Kathie, UC Davis Medical Center, Sacramento, California, United States
- Zhu, Elizabeth, UC Davis Medical Center, Sacramento, California, United States
- Rieland, Andrea, UC Davis Medical Center, Sacramento, California, United States
- Roach, Denise M., UC Davis Medical Center, Sacramento, California, United States
- Brown, Jennifer, UC Davis Medical Center, Sacramento, California, United States
Background
Cytomegalovirus (CMV) is a common opportunistic pathogen in renal transplant recipients (RTR) and is known to cause significant morbidity and mortality. To prevent CMV infection and disease, this single center academic institution utilizes both valganciclovir prophylaxis and continued monitoring through the outpatient transplant refill and mailing program (RAMP). The purpose of this study is to determine the incidence of CMV infection and disease in RTR who received valganciclovir and were enrolled in RAMP.
Methods
This is a retrospective, single center, cohort study of adult RTR between 2014-2016. Patients were eligible if enrolled in RAMP, >18 years old, and able to take oral valganciclovir. The primary endpoint was the incidence of CMV infection or disease in the first year post-transplant. The secondary endpoint was the dose of valganciclovir at various time intervals post-transplant for a subgroup of 100 patients (including all patients with infection and disease).
Results
A total of 418 RTR of CMV high risk (Donor+/Recipient-) and intermediate risk (D+/R+, D-/R+) were included. Most were male (59%) and of Hispanic (38%) or Caucasian (26%) descent. Their mean age was 51 years old (range 18 to 81). Of the 418 patients, CMV infection occurred in 15 (3.6%) and disease occurred in 2 (0.48%), with the majority of these cases occurring in the D+/R- group (11/17). For the subgroup of 100 patients evaluated for valganciclovir dosing, 50% of patients were dosed higher and 20% were dosed lower than recommended at hospital discharge. At weeks 4, 8, and 12 post-transplant 54-58% received lower and 12-20% received higher dosing than recommended.
Conclusion
The incidence of CMV infection and disease was lower than what is reported in the literature, with the highest prevalence in the D+/R- group. A combination of outpatient monitoring through RAMP and aggressive upfront dosing, followed by subsequent dose reductions in the outpatient setting likely contributed to the low rate of CMV infection and disease.