P242
CMV prophylaxis in renal transplant patients within the
Northern region during 2011 and 2012.
R. Davison1,3, F. Dowen1, J. Palfrey2,, E. Montgomery4, F. Dallas 4, D. Reaich2, M.
Valappil1 & K. Jones1.
1
Freeman Hospital, Newcastle upon Tyne, 2 James Cook University Hospital, Middlesbrough, 3
Sunderland Royal Hospital, Sunderland, 4 Cumberland Infirmary, Carlisle.
BACKGROUND: Cytomegalovirus (CMV) related disease is a significant cause of morbidity
and mortality following renal transplantation. Our CMV protocol recommends prophylaxis with
Valganciclovir for all donor positive / recipient negative (D+/R-) patients or any donor positive
or recipient positive combination if T-cell depleting agents are used. This should be commenced
within 10 days of transplantation and continued for 100 days except in high-risk patients (e.g.
D+/R- receiving Campath ®) who continue prophylaxis for 200 days.
AIM: To document the incidence of CMV viraemia and disease, along with protocol adherence
in renal transplant recipients from 01/01/11 to 31/12/12. To compare protocol adherence to
previous data collected between 2005-2010.
METHODS: All patients who received a kidney or simultaneous pancreas kidney transplant
(SPK) between 01/01/11–31/12/12 were included in our study. Data was collected from all
patients who had transplant follow up in the 4 renal units, in the North East and Cumbria.
Retrospective data was collected from patient notes and pathology systems. We assessed
donor/recipient status, prophylaxis prescription (drug, dose and duration) and evidence of CMV
viraemia or disease, treatment and complications.
RESULTS: Between 01/01/2011 – 31/12/2012 a total of 214 patients received a kidney or SPK
transplant. Based on our protocol 59 (27.6%) met the criteria for CMV prophylaxis of whom 52
(88%) received Valganciclovir. The dose was correct in 96.6% of these patients and the duration
correct in 78%. Of those who were prescribed an incorrect duration, 60% had the prophylaxis
continued on longer than the protocol recommendations.
There were 22 (10.3%) cases of CMV (15 with CMV disease and 7 with viraemia), 11 of whom
were high risk according to our protocol. All 22 of these patients received prophylaxis however
one patient had too low a dose and in two patients the prophylaxis was discontinued too early.
In patients with CMV infection there was a low incidence (1 person (4.5%)) of new onset
diabetes after transplant (NODAT). There were no cases of acute rejection (AR). Of the 32
patients who received T-cell depleting agents (Campath®), one had low level viraemia detected.
Of the 15 cases of CMV disease, 14 were successfully treated and one patient died as a result of
CMV pneumonitis.
When compared to our previous data collected between 2005-2010, there was a lower incidence
of CMV infection (10.3% compared to 12.5%), a decrease in acute rejection in those with CMV
infection (18.8% down to 0%) and a fall in NODAT following CMV infection from 11.4% to
4.5%.
CONCLUSION: Adherence to our CMV prophylaxis protocol since 2010 has improved and
we have noted a small reduction in CMV infection. However we are still only correctly
prescribing prophylaxis appropriately in 78% of patients. Documenting reasons for deviation
from the protocol is incomplete and it is not uncommon for us to continue prophylaxis longer
then protocol recommendations.