Low‐dose valganciclovir prohylaxis is efficacious and safe in cytomegalovirus seropositive heart transplant recipients with anti‐thymocyte globulin

• Published in: Transplant infectious disease 2018-06, Vol.20 (3), p.e12868-n/a
• Main Authors: Eriksson, Mari, Jokinen, Janne J., Söderlund, Sanni, Hämmäinen, Pekka, Lommi, Jyri, Lemström, Karl
• Format: Article
• Language: English
• Subjects: Antiviral drugs; Cytomegalovirus; Ganciclovir; Globulins; Heart; heart transplant; Heart transplantation; Patients; Prophylaxis; valganciclovir
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.12868

Background Cytomegalovirus (CMV) remains an important pathogen in solid organ transplant patients. Objective We executed a hybrid prophylactic and pre‐emptive valganciclovir (VGCV) prophylaxis to prevent CMV infection in heart transplant patients with anti‐thymocyte globulin (ATG) induction and retrospectively evaluated the efficacy and safety of this regimen. Methods Hundred adult heart transplant patients between 2004 and 2010 were included. Recipients with CMV serostatus D+/R− received VGCV 900 mg OD for 6 months and 94.2% (81/86) of R+ recipients received a low‐dose 450 mg OD for 3 months. Blood CMV was monitored until 3 months after cessation of the prophylaxis. Results All patients accomplished the prophylaxis. The overall incidence of CMV disease was 4% (4/100) and it was more frequent in D+/R− patients (P = .001). Three of eighty‐six (3.5%) of R+ patients had CMV infection (one CMV disease) while on prophylaxis, 2/3 were still on the original significantly reduced renal dose though. There was one late CMV disease in both D+/R− and R+ groups. Ganciclovir/VGCV treatment was successful in all patients. Conclusions The hybrid strategy with low‐dose VGCV in R+ patients with ATG was efficient and safe. The good treatment results indicate that the regimen did not lead to a clinically relevant resistance. Optimal renal dosage is essential throughout prophylaxis.