Valganciclovir 900 Mg Versus 450 Mg For Cytomegalovirus (CMV) Prophylaxis Following Renal Transplant

In Moderate Risk Recipients; A Four Year Single Center Experience.

1
Candidate ,

Budoor Aloumi, PharmD

Delal Alkortas, Pharm.D., BCPS,
1
2
Princess Nora Bint Abdulrahman University , King Faisal Specialist Hospital and Research Center , Riyadh, Saudi Arabia
Introduction

Materials & Methods

Cytomegalovirus (CMV) is a DNA virus

that belongs to the herpesvirus family.
CMV infection can be transmitted through
direct contact with infected blood, tissues
and bodily fluids.1 It is the most
commonly
recognized
opportunistic
pathogen in immunocompromised host.

This is a retrospective single center study

conducted at KFSH&RC.

In the absence of prophylaxis, acute

infection is most likely to occur between
the first and third month following
transplant, when immunosuppressants are
intensely administered. This infection can
occur acutely or as reactivation of latent
virus.3
Valganciclovir (VGC) 900 mg is approved
for CMV prophylaxis, but it has been
associated with 10%40% leukopenia
rate. A meta-analysis shows that VGC 900
mg was associated with 3 times increase
in the risk of leukopenia and 2 times
increase in the risk of rejection compared
with VGC 450 mg. 7

2
BCACP

Results cont.

Valganciclovir (VGC) 900 mg/d showed

equivalent efficacy compared with 450
mg/d prophylactic dose. Sever cases of
anemia
and
the
development
of
leukopenia were more frequent with high
dose valganciclovir.

14

All patients who fulfill the inclusion and

exclusion criteria were included. They were
identified from the renal transplant
registry. All data was collected by a single
investigator through electronic and paper
medical charts.

12

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References
8

All the statistical analysis of data was done

by using the software package SAS version
9.4 (SAS Institute Inc., Cary, NC, USA) and
SPSS.
Descriptive statistics for the continuous
variables reported as mean standard
deviation
and
categorical
variables
summarized
as
frequencies
and
percentages.
Continuous
variables
compared by Students t-test while
categorical variables compared by Chisquare test. The level of statistical
significance is set at p < 0.05.

Results

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2006.
2. D. C. Brennan, Cytomegalovirus in Renal Transplantation,
JASN, vol. 12, no. 4, pp. 848855, Apr. 2001.
3. B. C. Weikert and E. A. Blumberg, Viral infection after renal
transplantation: surveillance and management, Clinical
Journal of the American Society of Nephrology, vol. 3, no.
Supplement
2,
pp.
S76S86,
2008.
4. " Acute cytomegalovirus (CMV) infection(Medline Plus),
[online]
2015
http://www.nlm.nih.gov/medlineplus/ency/article/000568.htm
(Accessed: 7 June 2015). 5. S. Karuthu and E. A. Blumberg,
Common infections in kidney transplant recipients, Clinical
Journal of the American Society of Nephrology, vol. 7, no. 12,
pp.
20582070,
2012.
6. C. N. Kotton, CMV: prevention, diagnosis and therapy,
American Journal of Transplantation, vol. 13, no. s3, pp. 2440,
2013.
7. A. C. Kalil, C. Mindru, and D. F. Florescu, Effectiveness of
valganciclovir 900 mg
versus 450 mg for cytomegalovirus prophylaxis in
transplantation: direct and indirect treatment comparison
meta-analysis, Clinical Infectious Diseases, p. ciq143, 2010.
8. Gabardi, Steven, et al. "Evaluation of Low-Versus High-Dose
Valganciclovir for Prevention of Cytomegalovirus Disease in
High-Risk Renal Transplant Recipients." Transplantation
(2015).

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900 Mg/d - High Dose VGC
Anemia

Leukopenia

450 Mg/d - Low Dose VGC

Neutropenia

Thrombocytopenia

BPAR

Aim of the study

Conclusion

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The aim of the present study is to compare

450 mg/d versus 900 mg/d prophylactic
dose of Valganciclovir in renal transplant
recipients
at
moderate
risk
of
cytomegalovirus (CMV) infection in term of
and efficacy.

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Acknowledgements

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Contact Information

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0

0
900 Mg/d - High
Dose VGC

CMV syndrome

450 Mg/d - Low

Dose VGC

CMV tissue invasive disease

Asymptomatic viremia