Department of Pharmacy, NYU Langone Health, New York, NY, USA.
Department of Pharmacy, Tufts Medical Center, Boston, MA, USA.
Ann Pharmacother. 2025 Jan;59(1):34-40. doi: 10.1177/10600280241255110. Epub 2024 May 27.
Low-dose valganciclovir (VGC) for cytomegalovirus (CMV) prophylaxis post-transplant has been employed due to cost and safety. The incidence of CMV disease in CMV intermediate-risk liver recipients at 1-year after standard-dose prophylaxis is approximately 5%. However, there are limited data on outcomes after using a "true" low-dose VGC prophylaxis regimen in liver and dual-abdominal transplant recipients as VGC was not dose-adjusted in all patients with impaired renal function in prior studies.
The objective was to assess the incidence of CMV associated with low-dose VGC prophylaxis in CMV intermediate-risk liver, simultaneous pancreas-kidney (SPK), and simultaneous liver-kidney (SLK) recipients with creatinine clearance (CrCl) >60 mL/min.
This was a retrospective review of CMV intermediate-risk liver, SPK, and SLK recipients with CrCl >60 mL/min transplanted January 2018 to June 2022 who received VGC 450 mg daily for prophylaxis. The primary outcome was incidence of CMV infection 6-months post-transplant.
Ninety-nine transplant recipients were included (79 liver, 11 SPK, 9 SLK). The primary outcome occurred in 13% of patients (liver 10%, SPK 36%, SLK 10%), including 1 case of CMV disease and 3 breakthrough infections. In addition, 6 patients experienced CMV infection between 6-months and 1-year. Recurrence occurred in 3 patients. There was no evidence of CMV resistance. Thirty patients experienced neutropenia within 1-year, 32 were prescribed granulocyte-colony stimulating factors, and 5 experienced thrombocytopenia. Two patients died due to graft-vs-host disease.
Low-dose VGC prophylaxis led to comparable CMV infection rates at 6-months in CMV intermediate-risk liver and SLK recipients. However, as SPK recipients displayed higher rates of CMV infection, low-dose VGC should be avoided in this population.
由于成本和安全性的原因，移植术后采用低剂量缬更昔洛韦（VGC）进行巨细胞病毒（CMV）预防。在标准剂量预防后，CMV 中等风险肝移植受者在 1 年内发生 CMV 疾病的发生率约为 5%。然而，在既往研究中，由于所有肾功能受损的患者均未调整 VGC 剂量，因此在肝和双腹部移植受者中使用“真正”低剂量 VGC 预防方案的结果数据有限。
评估在肌酐清除率（CrCl）>60 mL/min 的 CMV 中等风险肝、同时胰腺-肾（SPK）和同时肝-肾（SLK）受者中，低剂量 VGC 预防与 CMV 相关的发生率。
这是一项回顾性研究，纳入了 2018 年 1 月至 2022 年 6 月期间接受 CrCl>60 mL/min 的 CMV 中等风险肝、SPK 和 SLK 移植的患者，这些患者每天接受 450 mg VGC 预防。主要结局是移植后 6 个月时 CMV 感染的发生率。
99 例移植受者纳入研究（79 例肝、11 例 SPK、9 例 SLK）。13%的患者（肝 10%，SPK 36%，SLK 10%）发生了主要结局，包括 1 例 CMV 疾病和 3 例突破性感染。此外，6 例患者在 6 个月至 1 年内发生 CMV 感染。3 例患者出现复发。未发现 CMV 耐药性。1 年内 30 例患者发生中性粒细胞减少症，32 例患者接受了粒细胞集落刺激因子治疗，5 例患者发生血小板减少症。2 例患者因移植物抗宿主病死亡。
低剂量 VGC 预防在 CMV 中等风险肝和 SLK 受者中导致了相似的 6 个月时 CMV 感染率。然而，由于 SPK 受者的 CMV 感染率较高，因此应避免在该人群中使用低剂量 VGC。
