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Transplant Proc. 2018 Oct;50(8):2485-2488. doi: 10.1016/j.transproceed.2018.04.010. Epub 2018 Apr 11.

Efficacy of Ultralow-Dose Valganciclovir Chemoprophylaxis for Cytomegalovirus Infection in ABO-Incompatible Kidney Transplantation Recipients.

Author information

1
Division of Nephrology, Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, Korea.
2
Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea.
3
Division of Nephrology, Department of Internal Medicine, Catholic University of Korea College of Medicine, Seoul, Korea.
4
Division of Nephrology, Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, Korea. Electronic address: sdhwang0902@gmail.com.

Abstract

BACKGROUND:

Cytomegalovirus (CMV) infection can increase morbidity and mortality in kidney transplant (KT) patients. Chemoprophylaxis with valganciclovir (VGCV) is recommended for ABO-incompatible (ABOi) KT patients as it significantly reduces CMV disease and infection. The recommended dose of VGCV for prevention of CMV in a KT recipient is 900 mg once daily, and the treatment duration is 6 months. However, because it is expensive, sufficient amounts might not be administered.

METHODS:

We investigated whether ultralow-dose VGCV (450 mg every other day) and short dosing period (3 months) was sufficient to prevent CMV infection after ABOi KT. We retrospectively evaluated 74 adult CMV-seropositive donor/CMV-seropositive recipient (D+/R+) ABOi KT recipients from June 2009 to July 2016 who received ultralow-dose VGCV prophylaxis for 3 months. The primary outcome was occurrence of CMV infection. Secondary outcomes were leukopenia and thrombocytopenia.

RESULT:

All patients received intravenous rituximab 200 mg once and plasmapheresis for reduction of anti-A/B antibodies and interleukin-2 antibodies before undergoing ABOi KT. Mean prophylaxis and follow-up durations were 3 and 52 months, respectively. One patient died of bacterial pneumonia. Four patients lost graft function and were undergoing hemodialysis; 3 cases were caused by antibody-mediated rejection, and 1 was due to mechanical complication after surgery. Fortunately, CMV infection did not occur in any patient.

CONCLUSION:

Ultralow-dose VGCV is an effective prophylaxis for D+/R+ ABOi KT recipients. Especially, ultralow-dose VGCV CMV infection prevention protocol in Asian populations reduced the side effects and cost.

[Indexed for MEDLINE]

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