SaO030EFFICACY AND SAFETY OF LOW DOSE VERSUS FULL DOSE VALGANCICLOVIR FOR PREVENTION OF CYTOMEGALOVIRUS DISEASE IN KIDNEY TRANSPLANT RECIPIENTS

Abstract

Introduction and Aims: Prophylaxis for cytomegalovirus infection is highly recommended for kidney transplant recipients. Using 900mg valganciclovir daily is the standard advice for such patients while using 450mg daily was investigated and found equally effective with fewer side effects in some studies. We aimed to evaluate the outcome of using two different doses of VGC prophylaxis among early KTRs regarding CMV infection, leukopenia attacks and rejection episodes. Methods: We prospectively randomized recent kidney transplants (1:1) to receive 450mg daily valganciclovir prophylaxis (group1) or 900mg daily (group2) for the first 6months post‐kidney transplant. Patients were studied for incidence of CMV disease, leukopenia attacks, rejection episodes and graft outcome over one year duration. Results: Demographic features of group1 (n=100) and group2 (n=101) were comparable. About 50% of patients received thymoglobulin induction therapy without difference between the groups. More patients have received tacrolimus in group1, while in group2 more patients were maintained on cyclosporine (p=0.001). There were more leukopenia attacks in group2 (p=0.04) requiring higher doses of granulocyte‐colony stimulating factor (p=0.03). Gruop2 patients received lower doses of mycophenolate mofitel (p=0.04), reduced doses of valgaciclovir (p=0.07) and have developed more rejection episodes (p=0.01). In group2; there were more cytomegalovirus infections requiring full treatment (p=0.052) and more BK virus nephropathy (p=0.03). Graft and patient outcomes were satisfactory in both groups. Mean estimated glomerular filtration rates were above 60 ml/ min at baseline, at 6months and at 12months post‐transplant for both groups. Conclusions: After one year follow up, low dose valganciclovir for post‐renal transplant cytomegalovirus prophylaxis was more effective and safer (less leukopenia attacks, less manipulation of chemoprophylactic and immunosuppressive drugs and fewer rejection episodes) than high dose.