scholarly journals 1703. Hematologic Toxicity of Valganciclovir Prophylaxis in Solid Organ Transplant Recipients as a Function of Weight-adjusted Ganciclovir Exposure

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S834-S835
Author(s):  
Toni A Campanella ◽  
Amanda Roy ◽  
Thomas J Gintjee ◽  
Monica Donnelley ◽  
Conan MacDougall ◽  
...  
Keyword(s):  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Hematologic Toxicity ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Medical Centers ◽  
Academic Medical ◽  
First Occurrence ◽  
The Impact ◽  
Cmv Prophylaxis

Abstract Background Valganciclovir (VGC), an oral prodrug of ganciclovir (GCV), is 60% bioavailable. Manufacturer-recommended doses are adjusted for creatinine clearance (CrCl), but not weight (wt), while GCV doses are adjusted for CrCl and wt. Patients exposed to excess GCV by not wt-adjusting VGC doses may be at risk of hematologic toxicity. The purpose of this study was to investigate the impact of body weight on VGC toxicity in solid organ transplant (SOT) recipients. Methods This was a multicenter retrospective study at three academic medical centers of adult SOT recipients who received VGC for CMV prophylaxis between January 2016 and August 2019. The primary outcome was first occurrence of leukopenia within six months post-transplant. The primary predictor was the ratio between the patient’s estimated GCV exposure based on the initial VGC dose prescribed and the equivalent prophylactic GCV dose accounting for the patient’s CrCl and wt (rVGC:GCV). Results The study included 231 patients, mostly lung (59%) and kidney (KT, 28%) transplants (Table 1). The rVGCV:GCV was 4.4 (range, 0.6-25.1, SD 4.5), and was significantly higher in KT (7.7 vs 3.0, p < 0.001). Leukopenia occurred in 133 patients (57.5%). After adjustment for type of transplant, rVGC:GCV ratio was not associated with increased odds (OR 0.97, 95% CI 0.91-1.04) or hazard of (HR 0.99, 95% CI 0.95-1.04) leukopenia. Exploratory analysis suggested threshold effects and interaction with transplant type: a rVGCV:VGC of > 3 was associated with time to leukopenia (HR 2.02, 95% CI 1.09-3.74) among non-KT patients but not KT patients (HR 0.99, 95% CI 0.56-1.76) (Figure 1). Table 1 Figure 1 Conclusion Initial doses of VGC used for SOT CMV prophylaxis are estimated to result in significantly higher GCV exposures than IV GCV doses. A relationship with risk of leukopenia was only seen in non-KT patients, possibly because of rapid recovery of renal function and dose adjustment in KT patients. Disclosures Jason C. Gallagher, PharmD, FIDP, FCCP, FIDSA, BCPS, Allergan (Consultant)Astellas (Consultant)Merck (Consultant, Grant/Research Support)Nabriva (Consultant)Qpex (Consultant)scPharmaceuticals (Consultant)Shionogi (Consultant)Spero (Consultant)Tetraphase (Consultant)

scholarly journals 1551. The Impact of Recurrent CMV Disease on Long-Term Survival in Solid Organ Transplant Recipients

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S481-S482 ◽  
Author(s):  
Bradley Gardiner ◽  
Jennifer Chow ◽  
Sam Brilleman ◽  
Anton Peleg ◽  
David Snydman
Keyword(s):  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Term Survival ◽  
Long Term Survival ◽  
Solid Organ Transplant Recipients ◽  
Cmv Disease ◽  
The Impact

The Impact ofClostridium difficileInfection on Future Outcomes of Solid Organ Transplant Recipients

2018 ◽  
Vol 39 (5) ◽  
pp. 563-570 ◽  
Author(s):  
Ruihong Luo ◽  
Janice M. Weinberg ◽  
Tamar F. Barlam
Keyword(s):  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Control Group ◽  
Solid Organ ◽  
Increased Risk ◽  
Significant Difference ◽  
First Occurrence ◽  
Future Outcomes ◽  
The Impact

OBJECTIVEClostridium difficileinfection (CDI) is common in solid organ transplant (SOT) recipients, but few studies have examined long-term outcomes. We studied the impact of CDI after SOT on mortality and transplant organ complication-related hospitalizations (TOH).METHODSSOT recipients ≥18 years of age with at least 1 year of posttransplant data were analyzed using the MarketScan database for 2007–2014. Patients who died within one year of transplant were followed until death. Patients were grouped as early CDI (ie, first occurrence ≤90 days posttransplant), late CDI (ie, first occurrence >90 days posttransplant) and controls (ie, no CDI occurrence during follow-up). The risk of mortality or TOH after CDI was evaluated using Cox and logistic regressions, respectively.RESULTSOverall, 96 patients had early CDI, 97 patients had late CDI, and 5,913 patients were used as controls. The risk for death was significantly higher in the early CDI group than the control group (hazard ratio [HR],1.92; 95% confidence interval [CI], 1.12–3.29;P=.018); there was no significant difference between the late CDI group and the control group (HR, 0.86; 95% CI, 0.38–1.94;P=.717). Both the early CDI group (odds ratio [OR], 2.19; 95% CI, 1.45–3.31;P<.001) and the late CDI group (OR, 4.36; 95% CI, 2.84–6.71;P<.001) had higher risk for TOH than the control group. For those patients who survived >90 days posttransplant, both the early CDI group (n=89) and the late CDI group (n=97) had increased risk for death or TOH during follow-up than the control group (n=5,734).CONCLUSIONThough our study could not prove causality, both early and late CDI occurrence in SOT recipients were associated with worse future outcomes than for SOT recipients without CDI.Infect Control Hosp Epidemiol2018;39:563–570

scholarly journals Electronic Estimations of Renal Function Are Inaccurate in Solid-Organ Transplant Recipients and Can Result in Significant Underdosing of Prophylactic Valganciclovir

2013 ◽  
Vol 57 (8) ◽  
pp. 4058-4060 ◽  
Author(s):  
J. Trevillyan ◽  
P. Angus ◽  
E. Shelton ◽  
J. Whitlam ◽  
F. Ierino ◽  
...  
Keyword(s):  
Filtration Rate ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Urine Creatinine ◽  
Solid Organ Transplant Recipients ◽  
A Prospective Study ◽  
Cmv Prophylaxis

ABSTRACTIn a prospective study of solid-organ transplant recipients (n= 22; 15 hepatic and 7 renal) receiving valganciclovir for cytomegalovirus (CMV) prophylaxis, electronic estimation of glomerular filtration rate (eGFR) underestimated the true GFR (24-h urine creatinine clearance) by >20% in 14/22 (63.6%). Its use was associated with inappropriate underdosing of valganciclovir, while the Cockroft-Gault equation was accurate in 21/22 patients (95.4%). Subtherapeutic ganciclovir levels (≤0.6 mg/liter) were common, occurring in 10/22 patients (45.4%); 7 had severely deficient levels (<0.3 mg/liter).

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