MP687SUCCESSFUL COST EFFECTIVE PREVENTION OF CYTOMEGALOVIRUS DISEASE IN KIDNEY TRANSPLANT RECIPIENTS USING LOW DOSE VALGANCICLOVIR

Abstract

Introduction and Aims: Prophylaxis for cytomegalovirus infection is highly recommended for kidney transplant recipients. Using valgancyclovir in low dose is still under investigation. Our aim was to assess the cost effectiveness of 450mg valgancyclovir prophylaxis compared with 900mg for kidney transplants. Methods: In this prospective trial, 201 kidney transplants were randomized (1:1) to receive 450mg valgancyclovir prophylaxis (group1, n=100) or 900mg daily (group2, n=101) for 6months post‐transplant. Patients were studied for incidence of CMV disease, leucopenia attacks, rejection episodes and graft outcome and associated costs in 1‐year duration. Direct costs of immunosuppressive medications, diagnosing and management of any rejection episodes, and hospitalizations were included. The cost were measured in US dollars. Results: Demographic features of the studied groups were comparable. More patients have received tacrolimus in group1, while more patients were maintained on cyclosporine in group2 (p0.001).We found that the cost of CVM prophylaxis in patients of group 1 was significantly lower (by 50% at 6 months, p<0.001) with lower leucopenia attacks (p 0.04) and lower doses of granulocyte colony stimulating factor (by 30 % at 6 months, p 0.03) compared to group 2. Higher doses of mycophenolate mofetil (p 0.04) among group 1 patients were protective therefore they experienced less rejection episodes (p0.01).In group2; there were more CMV infections requiring full treatment (p0.052) and more BK virus nephropathy (p0.03). Graft and patient outcomes were comparable. Mean estimated glomerular filtration rates were above 60 ml/min at baseline, at 6months and at 12months post‐transplant for both groups. Conclusions: Low dose valgancyclovir for cytomegalovirus prophylaxis after renal transplant is safer, effective without breakthrough infection and less costly than using usual dose.