Role of Secondary Prophylaxis With Valganciclovir in the Prevention of Recurrent CMV Disease in Solid Organ Transplant Recipients
Gardiner, Bradley.
2017
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Abstract: Reactivation of latent cytomegalovirus (CMV) infection is a major
cause of morbidity and mortality in solid organ transplant recipients (SOTR). Ganciclovir
and valganciclovir are highly effective antiviral drugs whose role in the treatment of CMV
disease and primary prophylaxis is well established. The efficacy of secondary prophylaxis
following the successful completion of CMV treat... read morement is, however, not clear. The objectives
of this study were to examine the effect of secondary prophylaxis with valganciclovir on
the likelihood of relapse in SOTR who had completed treatment for an episode of CMV
disease. We performed a single-center retrospective cohort study of SOTR from 1995-2015 and
used propensity score based inverse probability of treatment weighting methodology to
control for confounding by indication. A weighted Cox proportional hazards model was
created to determine the effect of SP on time to relapse within 1 year of treatment
completion. A total of 170 heart, liver and kidney transplant recipients who were treated
for an episode of CMV disease were included. One hundred and twenty (70.6%) received SP for
a median duration of 61 days, with a range of 5 to 365 days. Thirty-nine patients (23%)
relapsed. Use of SP was protective against relapse from 0 to 6 weeks following treatment
completion (hazard ratio, HR 0.19, 95% CI 0.05-0.69) but after this period of time, risk of
relapse did not significantly differ between the two groups (HR 1.18, 95% CI 0.46-2.99).
Our findings demonstrate that patients who received SP with valganciclovir were
significantly less likely to relapse during the initial 6 week period following completion
of treatment for CMV infection, but after this their risk of relapse was the same as those
who did not receive SP. SP should be considered a potentially effective strategy in
reducing ongoing morbidity and potentially mortality following CMV disease in
SOTR.
Thesis (M.S.)--Tufts University, 2017.
Submitted to the Dept. of Clinical & Translational Science.
Advisor: David Snydman.
Committee: Jennifer Chow, Lori-Lyn Price, Natalie Nierenberg, and David Kent.
Keywords: Medicine, and Virology.read less - ID:
- n296xb18q
- Component ID:
- tufts:22746
- To Cite:
- DCA Citation Guide EndNote
