Incidence and risk factors for the development of cytomegalovirus viremia in a steroid sparing liver transplant center

BACKGROUND: Cytomegalovirus (CMV) is a common opportunistic infection in patients after liver transplant (LT). Guidelines recommend 900 mg daily of valganciclovir; however, valganciclovir commonly causes dose‐dependent hematologic toxicities. Use of a low‐dose valganciclovir (450 mg) has been used to prevent these adverse effects, but the data regarding this dosing strategy are not as robust in a steroid sparing LT center. METHODS: Retrospective chart review of adult LT recipients between January 1, 2008 and June 30, 2019. All patients received low‐dose valganciclovir 450 mg PO daily for CMV prophylaxis. Primary outcome was the incidence of CMV viremia in LT recipients at 12 months post‐LT. Secondary outcomes include time to CMV viremia, risk factors for the development of CMV viremia, and incidence of breakthrough CMV viremia while on valganciclovir prophylaxis. RESULTS: A total of 266 patients were included. Overall, the majority were male (63.2%) and Caucasian (45.5%). The most common indication for transplant was decompensated cirrhosis (82%). The incidence of CMV at 1 year posttransplant was 7.9%. Independent risk factors included high risk status (OR 5.97, 95% CI 2.14–16.61, p = .001) as well as having an episode of rejection (OR 5.99, 95% CI 2.16–16.66, p = .001). CONCLUSION: Low‐dose valganciclovir can be effective in the prevention of CMV viremia in LT patients and may be a beneficial strategy for CMV prophylaxis in a steroid‐sparing transplant center. Further studies may be needed to determine appropriate length of prophylaxis therapy for different risk groups. [Image: see text]