Comparison of Short versus Extended Valganciclovir Prophylaxis in Donor-Positive Recipient-Negative Mismatched Heart Transplant Recipients: An Observational Study.

BACKGROUND

Recommendations remain unclear between a shorter or extended CMV prophylaxis duration in donor seropositive/recipient seronegative (D+/R-) heart transplant recipients. The purpose of our study is to evaluate the effectiveness of a short (less than 145 days) versus extended (145 days or more) duration of CMV prophylaxis with ganciclovir (GCV)/valganciclovir (VGCV) for prevention of CMV viremia in this high-risk patient population.

METHODS

A retrospective cohort study was conducted of adult (age ≥ 18 years) CMV D+/R- heart transplantation recipients who received intravenous (IV) GCV or oral (PO) VGCV after transplant for CMV prophylaxis. CMV viremia/disease, time to CMV viremia/disease, hospitalizations, and mortality within the first year of transplant were assessed.

RESULTS

A total of 55 D+/R- heart transplant recipients were included in this study, with 28 recipients receiving short duration prophylaxis and 27 recipients receiving extended duration. The median (IQR) duration of therapy for the short and extended duration groups was 76 (69-100) and 189 (168-278) days, respectively. There were similar rates of CMV viremia (35.7% vs. 48.1%; p = 0.35) and CMV disease (10.7% vs. 11.1%, p = 0.96) between the short and extended duration prophylaxis groups. The outcomes of time to CMV from transplant, CMV hospitalization, and mortality were also similar between groups.

CONCLUSION

In the present study, no difference was observed in the incidence of CMV viremia within 1 year between short versus extended duration of GCV/VGCV prophylaxis in CMV D+/R- heart transplant recipients. Prospective studies with a larger sample size may be needed to confirm this finding.