Evaluation of a Weight‐based Rabbit Anti‐thymocyte Globulin Induction Dosing Regimen for Kidney Transplant Recipients

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/113166/1/phar1624.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/113166/2/phar1624_am.pd

Comparison of standard versus low‐dose valganciclovir regimens for cytomegalovirus prophylaxis in high‐risk liver transplant recipients

PurposeThe purpose of this study was to compare the safety and efficacy of two valganciclovir (VGCV) institutional dosing protocols for cytomegalovirus (CMV) prophylaxis in liver transplant (LT) recipients with CMV serotype donor +/recipient‐ (D+/R−).MethodsThis was a single‐center review of CMV D+/R− adult LT recipients who received VGCV 450 mg/day for 90 days (low‐dose) or VGCV 900 mg/day for 180 days (standard‐dose). The primary outcome was incidence of CMV disease at 1 year. Secondary outcomes included rates of CMV syndrome, end‐organ disease, breakthrough infection, and resistance. Neutropenia, early discontinuation of VGCV, growth colony stimulating factors use (G‐CSF), biopsy‐proven rejection (BPAR), graft loss, and death at 1 year were analyzed.ResultsNinety‐six CMV D+/R− LT recipients were included. Although no difference in CMV disease was observed (low‐dose 26% vs. standard‐dose 23%, p = 0.71), 75% of CMV infections in the low‐dose group presented with end‐organ disease. Ganciclovir (GCV) resistance was observed only in the low‐dose group (n = 2). Significantly more patients in the standard‐dose group developed neutropenia (low‐dose 10% vs 60% standard‐dose, p < 0.001). In the standard‐dose group, 29% required early discontinuation of VGCV (vs. 5% in the low‐dose group, p < 0.001), and 20% were treated with G‐CSF. Both cohorts had similar rates of BPAR, graft loss, and death at 1 year.ConclusionsVGCV 900 mg/day for 180 days had higher rates of hematologic adverse effects resulting in frequent treatment interruptions. However, the occurrence of two cases of GCV‐resistant CMV disease raises concerns about routinely using low‐dose VGCV prophylaxis.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/170889/1/tid13713.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/170889/2/tid13713_am.pd

Oropharyngeal candidiasis outcomes in renal transplant recipients receiving nystatin versus no antifungal prophylaxis

ObjectiveTo compare the incidence of oropharyngeal candidiasis (OC), or thrush, in renal transplant recipients receiving nystatin versus no antifungal prophylaxis.MethodsThis was a single‐center, retrospective, non‐inferiority study of adult renal transplant recipients (RTRs) who received nystatin for 30 days for OC prophylaxis (nystatin group) or no antifungal prophylaxis therapy (No PPX group). The primary outcome was the incidence of OC within 3 months post‐transplant. Secondary outcomes included time to OC occurrence and severity of OC. The pre‐specified non‐inferiority margin was 10%.ResultsThe incidence of OC within 3 months post‐transplant among 257 RTRs was 7.8% (10/128) in the No PPX group and 4.7% (6/129) RTRs in the nystatin group, a risk difference of 3.2% (95% CI, −2.7% to 9.1%, non‐inferiority P = .04). The median time to OC was 7.5 days (IQR 6.3‐34.3 days) in the nystatin group and 9.5 days (IQR 5.3‐30.5 days) in the No PPX group (P = .64). Esophageal candidiasis was observed in 10% (1/10) of RTRs with OC in the No PPX group compared to 16.7% (1/6) RTRs in the nystatin group (P = 1.00). All RTRs with OC achieved symptom resolution with fluconazole and/or nystatin. Two patients in the No PPX group required readmission for decreased oral intake, and OC was diagnosed and treated during their hospital day.ConclusionsIn this retrospective study of adult RTRs, the absence of antifungal prophylaxis demonstrated non‐inferiority to 30‐day nystatin prophylaxis at reducing the incidence of OC within 3 months of transplant. OC prophylaxis may not be warranted after renal transplant.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/168352/1/tid13559_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168352/2/tid13559.pd

Oropharyngeal candidiasis outcomes in renal transplant recipients receiving nystatin versus no antifungal prophylaxis

ObjectiveTo compare the incidence of oropharyngeal candidiasis (OC), or thrush, in renal transplant recipients receiving nystatin versus no antifungal prophylaxis.MethodsThis was a single‐center, retrospective, non‐inferiority study of adult renal transplant recipients (RTRs) who received nystatin for 30 days for OC prophylaxis (nystatin group) or no antifungal prophylaxis therapy (No PPX group). The primary outcome was the incidence of OC within 3 months post‐transplant. Secondary outcomes included time to OC occurrence and severity of OC. The pre‐specified non‐inferiority margin was 10%.ResultsThe incidence of OC within 3 months post‐transplant among 257 RTRs was 7.8% (10/128) in the No PPX group and 4.7% (6/129) RTRs in the nystatin group, a risk difference of 3.2% (95% CI, −2.7% to 9.1%, non‐inferiority P = .04). The median time to OC was 7.5 days (IQR 6.3‐34.3 days) in the nystatin group and 9.5 days (IQR 5.3‐30.5 days) in the No PPX group (P = .64). Esophageal candidiasis was observed in 10% (1/10) of RTRs with OC in the No PPX group compared to 16.7% (1/6) RTRs in the nystatin group (P = 1.00). All RTRs with OC achieved symptom resolution with fluconazole and/or nystatin. Two patients in the No PPX group required readmission for decreased oral intake, and OC was diagnosed and treated during their hospital day.ConclusionsIn this retrospective study of adult RTRs, the absence of antifungal prophylaxis demonstrated non‐inferiority to 30‐day nystatin prophylaxis at reducing the incidence of OC within 3 months of transplant. OC prophylaxis may not be warranted after renal transplant.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/168352/1/tid13559_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168352/2/tid13559.pd