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. 2017 Nov 29;65(12):2000-2007.
doi: 10.1093/cid/cix696.

Role of Secondary Prophylaxis With Valganciclovir in the Prevention of Recurrent Cytomegalovirus Disease in Solid Organ Transplant Recipients

Bradley J Gardiner  1 , Jennifer K Chow  1 , Lori Lyn Price  2   3 , Natalie E Nierenberg  1 , David M Kent  3   4 , David R Snydman  1   3
Affiliations

Role of Secondary Prophylaxis With Valganciclovir in the Prevention of Recurrent Cytomegalovirus Disease in Solid Organ Transplant Recipients

Bradley J Gardiner et al. Clin Infect Dis. .

Abstract

Background: Cytomegalovirus (CMV) is a major contributor to morbidity and mortality in solid organ transplant recipients (SOTRs). Ganciclovir and valganciclovir are highly effective antiviral drugs with a well-established role in primary prophylaxis and treatment of CMV disease. Our objective in this study was to examine the effect of secondary prophylaxis (SP) on the risk of relapse in SOTRs following an episode of CMV disease.

Methods: We performed a retrospective cohort study of SOTRs from 1995 to 2015 and used propensity score-based inverse probability of treatment weighting methodology to control for confounding by indication. A weighted Cox model was created to determine the effect of SP on time to relapse within 1 year of treatment completion.

Results: Fifty-two heart, 34 liver, 79 kidney, and 5 liver-kidney transplant recipients who completed treatment for an episode of CMV infection/disease were included. A total of 120 (70.6%) received SP (median duration, 61 days; range, 5-365) and 39 (23%) relapsed. SP was protective against relapse from 0 to 6 weeks following treatment completion (hazard ratio [HR], 0.19; 95% confidence interval [CI], 0.05-0.69). However, after 6 weeks, risk of relapse did not significantly differ between the 2 groups (HR, 1.18; 95% CI, 0.46-2.99).

Conclusions: Our findings demonstrate that use of SP following treatment of CMV disease did not confer long-term protection against relapse, although it did delay relapse while patients were receiving antivirals. This suggests that SP has limited clinical utility in the overall prevention of recurrent CMV disease.

Keywords: cytomegalovirus; relapse; secondary prophylaxis; transplant; valganciclovir.

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Figures

Figure 1.
Figure 1.
Number and flow of study participants. Abbreviation: CMV, cytomegalovirus.
Figure 2.
Figure 2.
Kaplan-Meier plots showing the estimated probability of relapse-free survival in patients who did and did not receive secondary prophylaxis before (A) and after (B) adjustment for confounders by propensity score–based inverse probability weighting. P values refer to log-rank test results. Abbreviation: SP, secondary prophylaxis.
See this image and copyright information in PMC

References

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