AUTHOR=Hammer Nathalie , Hoessly Linard , Haidar Fadi , Hirzel Cédric , de Seigneux Sophie , van Delden Christian , Vogt Bruno , Sidler Daniel , Neofytos Dionysios 

TITLE=Pitfalls in Valganciclovir Prophylaxis Dose Adjustment Based on Renal Function in Kidney Transplant Recipients

JOURNAL=Transplant International

VOLUME=Volume 37 - 2024

YEAR=2024

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2024.12712

DOI=10.3389/ti.2024.12712

ISSN=1432-2277

ABSTRACT=CMV donor (D)+/recipient (R)-and CMV R+ after thymoglobulin-induction (R+/TG). Although VGC dose adjustments based on renal function are recommended, there is paucity of real-life data on VGC dosing and associations with clinical outcomes.Retrospective Swiss Transplant Cohort Study-embedded observational study including all adult D+/R-and R+/TG KTR between 2010 and 2020, who received prophylaxis with VGC. The primary objective was to describe the proportion of inappropriately (under-or over-) dosed VGC week-entries.Secondary objectives included breakthrough clinically significant CMV infection (csCMVi) and potential associations between breakthrough-csCMVi and cytopenias with VGC dosing.Results. Among 178 KTR, 131 (73.6%) patients ≥2 week-entries for the longitudinal data of interest and were included in the outcome analysis, with 1032 VGC dose week-entries. Overall, 460/1032 (44.6%) were appropriately dosed, while 234/1032 (22.7%) and 338/1032 (32.8%) were under-and over-dosed, respectively. Nineteen (14.5%) paeents had a breaktrough-csCMVi, without any associaeons idenefied with VCG dosing (p=0.44). Unlike other cytopenias, a significant association between VGC overdosing and lymphopenia (OR 5.27, 95%CI 1.71-16.22, p=0.004) was shown.Conclusions. VGC prophylaxis in KTR is frequently inappropriately dosed, albeit without meaningful clinical associations, neither in terms of efficacy nor safety.