Gheith Osama, Halim Medhat A, Al-Otaibi Torki, Mansour Hany, Mosaad Ahmed, Atteya Hassanein Abo, Zakaria Zakaria, Said Tarek, Nair Prasad, Nampoory Narayanam
Urology and Nephrology Center, Mansoura University, Mansoura, Egypt; Hamed Al-Essa Organ Transplant Center, Sabah Area, Kuwait.
Exp Clin Transplant. 2017 Feb;15(Suppl 1):156-163. doi: 10.6002/ect.mesot2016.P34.
Low-dose valganciclovir prophylaxis is still under investigation in renal transplant procedures. Our aim was to assess the cost effectiveness of 450 mg versus 900 mg valganciclovir prophylaxis in kidney transplant recipients.
In this prospective trial, 201 kidney transplant patients were randomized (1:1) to receive 450 mg/d (group 1, n = 100) or 900 mg/d (group 2, n = 101) valganciclovir prophylaxis for the first 6 months after transplant. Patients were studied for incidence of cytomegalovirus disease, leucopenia episodes, rejection episodes, and graft outcomes along with associated costs over 1 year. Costs (in US dollars) of treatment of rejection were also analyzed.
Demographic features of the studied groups were comparable. We found that the cost of cytomegalovirus care in group 1 patients was significantly lower (by 50% at 6 months; P < .001), with less leukopenia episodes (P = .04), lower doses of granulocyte colony-stimulating factor (by 30% at 6 months; P = .03), higher doses of mycophenolate mofetil (P = .04), and less rejection episodes (P = .01) compared with group 2. In group 2, there were more episodes of cytomegalovirus infection (P = .052) and BK virus nephropathy (P = .04). Graft and patient outcomes were satisfactory in both groups.
Low-dose valganciclovir for cytomegalovirus prophylaxis after renal transplant is safer, effective and without breakthrough infection, and less costly than using the usual dose.
低剂量缬更昔洛韦预防用药在肾移植手术中仍在研究中。我们的目的是评估肾移植受者中，450毫克与900毫克缬更昔洛韦预防用药的成本效益。
在这项前瞻性试验中，201例肾移植患者被随机分为两组（1:1），在移植后的前6个月分别接受450毫克/天（第1组，n = 100）或900毫克/天（第2组，n = 101）的缬更昔洛韦预防用药。对患者进行了1年的巨细胞病毒疾病发病率、白细胞减少发作、排斥发作、移植结果以及相关成本的研究。还分析了排斥治疗的成本（以美元计）。
研究组的人口统计学特征具有可比性。我们发现，与第2组相比，第1组患者的巨细胞病毒护理成本显著降低（6个月时降低50%；P <.001），白细胞减少发作更少（P =.04），粒细胞集落刺激因子剂量更低（6个月时降低30%；P =.03），霉酚酸酯剂量更高（P =.04），排斥发作更少（P =.01）。在第2组中，巨细胞病毒感染发作更多（P =.052），BK病毒肾病更多（P =.04）。两组的移植和患者结果均令人满意。
肾移植后使用低剂量缬更昔洛韦预防巨细胞病毒感染更安全、有效，无突破性感染，且成本低于常规剂量。
