Longer CMV Prophylaxis May Be Better

SEATTLE—Longer duration of prophylaxis against cytomegalovirus (CMV) is associated with a lower rate of CMV viremia in kidney transplants at high risk of CMV infection, according to new study findings presented at the 2013 American Transplant Congress.

The study, by John Patrick Sia, MD, and colleagues at the University of Nebraska in Omaha, enrolled 94 CMV-seronegative kidney transplant recipients who received an organ from a CMV-seropositive donor. Of these, 45 received a 100-day course of valganciclovir and 49 received a 200-day course of the drug. The primary endpoint was the development of CMV viremia within 12 months of transplantation.

The investigators found a significantly higher incidence of viremia among patients in the 100-day group (21/45, or 46.6%) compared with the 200-day group (9/49, or 18.3%) in the first year following transplantation.

In addition, 12 (26.6%) of the 45 patients in the 100-day group were hospitalized compared with six (12.2%) of the 49 patients in the 200-day group, but the difference was not statistically significant. Significantly more patients in the 100-day than the 200-day group, however, were re-hospitalized because of CMV (six vs. 0). The study revealed no difference in the rates of acute rejection, graft loss, or mortality between the groups.

The two groups were comparable except for immunosuppression management. The patients in the 100-day group were significantly less likely than those in the 200-day group to receive anti-thymocyte globulin induction. Most patients received mycophenolate and tacrolimus, but more patients in the 100-day group were maintained on prednisone.

Study findings suggest the duration of prophylaxis should be decided on a case by case basis, perhaps taking into account the level of immunosuppression, according to Dr. Sia. It might be appropriate, for example, to prescribe 200 days of prophylaxis for patients on more intensive immunosuppressive protocols.

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