Valganciclovir Underdosing Is Associated With Cytomegalovirus DNAemia During Universal Prophylaxis: A Real-Life Case...

Area of Science:

• Nephrology
• Infectious Diseases
• Pharmacology

Background:

• Cytomegalovirus (CMV) infection is a significant risk after kidney transplantation.
• Universal prophylaxis or preemptive strategies with valganciclovir (VGCV) are standard for prevention.
• Combining strategies during the first 3 months post-transplantation was investigated.

Purpose of the Study:

• To determine the incidence of CMV DNAemia during universal VGCV prophylaxis.
• To identify factors associated with CMV DNAemia in kidney transplant recipients.
• To evaluate VGCV underdosing in relation to kidney function assessment.

Main Methods:

• Retrospective, monocentric case-control study of 300 kidney transplant patients (2017-2020).
• Cases with CMV DNAemia were matched to four controls based on demographics, serostatus, and induction therapy.
• VGCV underdosing rates were compared, analyzing dosage adjustments against kidney function estimates.

Main Results:

• CMV DNAemia incidence was 5.1% despite VGCV prophylaxis.
• VGCV underdosing occurred more frequently in patients with CMV DNAemia.
• VGCV underdosing was the sole independent factor associated with CMV DNAemia (OR: 1.04).
• Resistance to ganciclovir (GCV) was noted in 4 of 15 cases.

Conclusions:

• CMV DNAemia post-kidney transplantation is significantly associated with VGCV underdosing.
• Inadequate adjustment of VGCV dosage or use of incorrect kidney function formulas may contribute to underdosing.
• Optimizing VGCV dosing strategies is essential for effective CMV prevention.