Impact of High‐Dose Acyclovir Cytomegalovirus Prophylaxis Failure in Abdominal Solid Organ Transplant Recipients

Abstract

Prophylaxis failure with HD-A was mostly limited to mild viremia; however, it was associated with significantly reduced long-term graft survival, likely reflecting the negative impact of CMV viremia.

The risk of cytomegalovirus infection after treatment of acute rejection in renal transplant recipients

“…While the finding of median time to development of CMV after rejection of approximately 1 year was somewhat unanticipated, it could be explained by the relatively long duration of effect expected from antithymocyte globulin and B cell‐directed therapies on immune function as well as the resultant up‐titration of the maintenance immunosuppressive regimen after rejection treatment paired with prophylactic strategies reducing incidence in the first few months after rejection treatment . Interestingly, median time to CMV infection after rejection did not change significantly when looking exclusively in the moderate risk (R+) population, who received high‐dose acyclovir . However, this is likely due to the trend toward increased use of lymphocyte depletion/B cell–directed therapies in the case group.…”

“…During this study period, seropositive patients (R+) received acyclovir 800 mg four times daily (high‐dose acyclovir) for 3 months after transplant and rejection treatment, if lymphocyte depletion was not utilized. In the setting of lymphocyte depletion, or high‐risk serostatus (seronegative recipients of seropositive allografts, D+/R−), VGC 900 mg daily adjusted for renal function was used for prophylaxis, as previously described . Additionally, methodology of CMV molecular diagnostic detection via PCR was stable throughout the study period.…”

Polyomavirus and cytomegalovirus infections are risk factors for grafts loss in simultaneous pancreas and kidney transplant

“…Seropositive recipients without lymphocyte depletion received acyclovir 800 mg four‐times daily renally adjusted, as previously described . After the publication of a pivotal clinical trial in 2010, the duration of valganciclovir prophylaxis was extended from 3 to 6 months in patients who qualified for this therapy . In 2015, the use of valganciclovir prophylaxis was extended to the entire R+ population based on the results of internal QI analysis .…”

“…After the publication of a pivotal clinical trial in 2010, the duration of valganciclovir prophylaxis was extended from 3 to 6 months in patients who qualified for this therapy . In 2015, the use of valganciclovir prophylaxis was extended to the entire R+ population based on the results of internal QI analysis . Despite these changes, the methodology of our CMV prophylactic protocol remained consistent.…”

The development and implementation of stewardship initiatives to optimize the prevention and treatment of cytomegalovirus infection in solid-organ transplant recipients

“…The clinical issues and associated burden of CMV infection have been well described, and thr management of CMV after SOT is complex. [18][19][20][21][22][23][24][25][26][27][28][29][30] The drug of choice has a narrow therapeutic index, and alternatives require careful patient selection. [31][32][33] Adding complexity is the central role of cell-mediated immunity in successful treatment of CMV, requiring immunosuppressive modification and increasing risk of rejection.…”