Healthcare resource use and clinical events associated with neutropenia among adult kidney transplant recipients receiving valganciclovir or ganciclovir prophylaxis: a matched case-control cohort study.

BACKGROUND

Cytomegalovirus prophylaxis with valganciclovir and ganciclovir is associated with increased neutropenia risk in kidney transplant recipients. This study assessed the association between neutropenia and short-term healthcare resource utilization (HCRU) and clinical events for adults receiving valganciclovir and/or ganciclovir prophylaxis post-kidney transplantation in the United States.

METHODS

Adult kidney transplant recipients from 2012 to 2020 who received valganciclovir and/or ganciclovir prophylaxis were identified in the TriNetX database. Patients with a neutropenia event during the 1-year post-kidney transplant were identified as cases and those without were identified as controls. Cases and controls were matched 1:1 on patient characteristics in the 1-year period before the kidney transplant. HCRU and clinical event rates in the year following the first neutropenia event were compared between the cases and controls.

RESULTS

Of 3564 identified case-control pairs, the average age was 52 years and 59.57% were male. Cases had higher HCRU in the first year after neutropenia than controls, characterized by 1.40-, 1.28-, and 1.33-times higher rates of inpatient, outpatient, and emergency department visits (all p < 0.001). Cases also had higher incident rates for cytomegalovirus-related events, use of granulocyte colony stimulating factor, and opportunistic infections (all adjusted incident rate ratios >1 with p < 0.01), and greater risks of death, graft loss, and acute graft rejection (all adjusted hazard ratios >1 with p < 0.001).

CONCLUSION

Higher HCRU and clinical burden were observed within the first year following post-transplant neutropenia. New options for cytomegalovirus prophylaxis that are less likely to induce neutropenia are needed to improve patient outcomes.