{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T18:58:51Z","timestamp":1790276331747,"version":"4.1.0"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2018,4,23]],"date-time":"2018-04-23T00:00:00Z","timestamp":1524441600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2018,4,23]],"date-time":"2018-04-23T00:00:00Z","timestamp":1524441600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver Transpl"],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:p>Liver transplantation recipients (LTRs) who are seropositive for cytomegalovirus (CMV) (recipient seropositive [R+]) are at intermediate risk for CMV disease. A preventative strategy following transplant is considered standard of care. Current guidelines recommend high\u2010dose valganciclovir (VGCV; 900 mg\/day adjusted for renal function) for prophylaxis given limited data on the efficacy and safety of low\u2010dose VGCV (450 mg\/day adjusted for renal function). We describe our experience using low\u2010dose VGCV prophylaxis for R+ LTRs at our institution. A single\u2010center, retrospective study was conducted using a database of 364 LTRs over a 4\u2010year period (2011\u20102014). Adult first\u2010time R+ LTRs receiving low\u2010dose VGCV prophylaxis were included. The primary endpoint was CMV disease at 1 year after transplant. Patients were compared with historical controls receiving high\u2010dose VGCV prophylaxis. Secondary endpoints were biopsy\u2010proven rejection and leukopenia on VGCV. With respect to leukopenia, patients receiving low\u2010dose VGCV were compared with a group of D+R\u2013 patients from the database receiving high\u2010dose VGCV. Univariate analyses were performed using chi\u2010squared, Fisher's exact, and Wilcoxon rank sum tests. A total of 200 R+ LTRs met inclusion criteria. Median age was 60 years (interquartile range [IQR], 54\u201066 years), and 129 (65%) LTRs were male. Median Model for End\u2010Stage Liver Disease score was 22 (IQR, 14\u201031), and 178 (89%) patients received deceased donor transplants. CMV disease occurred in only 9 (5%) patients, similar to rates in previous studies of LTRs receiving high\u2010dose VGCV. Biopsy\u2010proven rejection occurred in 18 (9%) patients. Patients received VGCV prophylaxis for a median of 3.4 (IQR, 3.1\u20104.3) months; 151 (76%) R+ LTRs receiving low\u2010dose VGCV developed leukopenia. Premature VGCV discontinuation and granulocyte\u2010colony stimulating factor use were infrequent and not significantly different between the 2 groups. In conclusion, low\u2010dose VGCV was safe and effective for prevention of CMV disease in our cohort of 200 R+ LTR and should be considered as an option in future guidelines. <jats:italic toggle=\"yes\">Liver Transplantation 24 616\u2013622 2018<\/jats:italic> AASLD.<\/jats:p>","DOI":"10.1002\/lt.25047","type":"journal-article","created":{"date-parts":[[2018,3,3]],"date-time":"2018-03-03T16:26:41Z","timestamp":1520094401000},"page":"616-622","source":"Crossref","is-referenced-by-count":14,"title":["Low\u2010dose valganciclovir for cytomegalovirus prophylaxis in intermediate\u2010risk liver transplantation recipients"],"prefix":"10.1097","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4371-9173","authenticated-orcid":false,"given":"Salman","family":"Khan","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases,New York,NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases,New York,NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohsin","family":"Ali","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai,New York,NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dallas","family":"Dunn","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases,New York,NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gopi","family":"Patel","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases,New York,NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shirish","family":"Huprikar","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases,New York,NY"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,4,23]]},"reference":[{"key":"lt25047-bib-0001-20240115","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1111\/ajt.14208","article-title":"Infection in organ transplantation","volume":"17","year":"2017","journal-title":"Am J Transplant"},{"issue":"suppl 1","key":"lt25047-bib-0002-20240115","first-page":"8","article-title":"Indirect effects of CMV on the solid organ transplant patient","volume":"1","year":"1999","journal-title":"Transpl Infect Dis"},{"key":"lt25047-bib-0003-20240115","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.jcv.2012.02.020","article-title":"Importance of the cytomegalovirus seropositive recipient as a contributor to disease burden after solid organ transplantation","volume":"54","year":"2012","journal-title":"J Clin Virol"},{"key":"lt25047-bib-0004-20240115","doi-asserted-by":"crossref","first-page":"4849","DOI":"10.3748\/wjg.14.4849","article-title":"Cytomegalovirus infection after liver transplantation: current concepts and challenges","volume":"14","year":"2008","journal-title":"World J Gastroenterol"},{"issue":"suppl 3","key":"lt25047-bib-0005-20240115","first-page":"24","article-title":"CMV: prevention, diagnosis and therapy","volume":"13","year":"2013","journal-title":"Am J Transplant"},{"key":"lt25047-bib-0006-20240115","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1097\/TP.0b013e31828ee12e","article-title":"International survey of cytomegalovirus management in solid organ transplantation after the publication of consensus guidelines","volume":"95","year":"2013","journal-title":"Transplantation"},{"key":"lt25047-bib-0008-20240115","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1097\/TP.0b013e31829df29d","article-title":"Updated international consensus guidelines on the management of cytomegalovirus in solid\u2010organ transplantation","volume":"96","year":"2013","journal-title":"Transplantation"},{"key":"lt25047-bib-0009-20240115","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1093\/cid\/ciq143","article-title":"Effectiveness of valganciclovir 900 mg versus 450 mg for cytomegalovirus prophylaxis in transplantation: direct and indirect treatment comparison meta\u2010analysis","volume":"52","year":"2011","journal-title":"Clin Infec Dis"},{"key":"lt25047-bib-0010-20240115","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1111\/tid.12609","article-title":"Multicenter evaluation of efficacy and safety of low\u2010dose versus high\u2010dose valganciclovir for prevention of CMV disease in donor and recipient positive (D+\/R+) renal transplant recipients","volume":"18","year":"2016","journal-title":"Transpl Infect Dis"},{"issue":"suppl 1","key":"lt25047-bib-0011-20240115","first-page":"156","article-title":"Successful cost\u2010effective prevention of cytomegalovirus disease in kidney transplant recipients using low\u2010dose valganciclovir","volume":"15","year":"2017","journal-title":"Exp Clin Transplant"},{"key":"lt25047-bib-0012-20240115","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1002\/lt.20562","article-title":"Efficacy and safety of low\u2010dose valganciclovir in the prevention of cytomegalovirus disease in adult liver transplant recipients","volume":"12","year":"2006","journal-title":"Liver Transpl"},{"key":"lt25047-bib-0013-20240115","doi-asserted-by":"crossref","first-page":"3266","DOI":"10.1016\/j.transproceed.2007.09.037","article-title":"Experience with low\u2010dose valganciclovir prophylaxis in adult liver transplant recipients","volume":"39","year":"2007","journal-title":"Transplant Proc"},{"key":"lt25047-bib-0014-20240115","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1093\/cid\/ciw668","article-title":"Definitions of cytomegalovirus infection and disease in transplant patients for use in clinical trials","volume":"64","year":"2017","journal-title":"Clin Infec Dis"},{"key":"lt25047-bib-0015-20240115","first-page":"419","article-title":"Cytomegalovirus treatment strategy after a liver transplant: preemptive therapy or prophylaxis for cytomegalovirus seropositive donor or recipient","volume":"14","year":"2016","journal-title":"Exp Clin Transplant"},{"key":"lt25047-bib-0016-20240115","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1111\/j.1477-2574.2010.00226.x","article-title":"Valganciclovir is an effective prophylaxis for cytomegalovirus disease in liver transplant recipients","volume":"12","year":"2010","journal-title":"HPB (Oxford)"},{"key":"lt25047-bib-0017-20240115","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1097\/01.tp.0000226071.12562.1a","article-title":"Impact of cytomegalovirus in organ transplant recipients in the era of antiviral prophylaxis","volume":"81","year":"2006","journal-title":"Transplantation"},{"key":"lt25047-bib-0018-20240115","doi-asserted-by":"crossref","first-page":"3182","DOI":"10.1016\/j.transproceed.2005.07.032","article-title":"Does valganciclovir hydrochloride (Valcyte) provide effective prophylaxis against cytomegalovirus infection in liver transplant recipients?","volume":"37","year":"2005","journal-title":"Transplant Proc"},{"key":"lt25047-bib-0019-20240115","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1002\/lt.23530","article-title":"Risk of cytomegalovirus disease in high\u2010risk liver transplant recipients on valganciclovir prophylaxis: a systematic review and meta\u2010analysis","volume":"18","year":"2012","journal-title":"Liver Transpl"},{"key":"lt25047-bib-0020-20240115","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1093\/cid\/cix793","article-title":"Use of viral load as a surrogate marker in clinical studies of cytomegalovirus in solid organ transplantation: a systematic review and meta\u2010analysis","volume":"66","year":"2018","journal-title":"Clin Infect Dis"},{"key":"lt25047-bib-0021-20240115","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1111\/tid.12349","article-title":"Increased risk of breakthrough infection among cytomegalovirus donor\u2010positive\/recipient\u2010negative kidney transplant recipients receiving lower\u2010dose valganciclovir prophylaxis","volume":"17","year":"2015","journal-title":"Transpl Infect Dis"},{"key":"lt25047-bib-0022-20240115","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1111\/j.1600-6143.2010.03074.x","article-title":"The efficacy and safety of 200 days of valganciclovir cytomegalovirus prophylaxis in high\u2010risk kidney transplant recipients","volume":"10","year":"2010","journal-title":"Am J Transplant"},{"key":"lt25047-bib-0023-20240115","doi-asserted-by":"crossref","first-page":"2056","DOI":"10.1016\/j.transproceed.2016.05.004","article-title":"Extended low\u2010dose valganciclovir is effective prophylaxis against cytomegalovirus in high\u2010risk kidney transplant recipients with near\u2010complete eradication of late\u2010onset disease","volume":"48","year":"2016","journal-title":"Transplant Proc"},{"key":"lt25047-bib-0024-20240115","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1111\/tri.12101","article-title":"Evaluation of clinical outcomes of prophylactic versus preemptive cytomegalovirus strategy in liver transplant recipients","volume":"26","year":"2013","journal-title":"Transpl Int"},{"key":"lt25047-bib-0025-20240115","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1111\/j.1399-0012.2006.00618.x","article-title":"Cytomegalovirus in transplantation \u2013 challenging the status quo","volume":"21","year":"2007","journal-title":"Clin Transplant"},{"key":"lt25047-bib-0027-20240115","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1086\/652438","article-title":"Cytomegalovirus seroprevalance in the United States: the national health and nutrition examination surveys, 1988\u20102004","volume":"50","year":"2010","journal-title":"Clin Infect Dis"},{"key":"lt25047-bib-0030-20240115","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1016\/j.drudis.2016.03.005","article-title":"Applying lessons learned from cytomegalovirus infection in transplant recipients to vaccine design","volume":"21","year":"2016","journal-title":"Drug Discov Today"},{"key":"lt25047-bib-0031-20240115","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1002\/lt.24216","article-title":"Targeted individual prophylaxis offers superior risk stratification for cytomegalovirus reactivation after liver transplantation","volume":"21","year":"2015","journal-title":"Liver Transpl"}],"container-title":["Liver Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Flt.25047","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/01445473-201805000-00008","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,15]],"date-time":"2024-01-15T01:15:03Z","timestamp":1705281303000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/01445473-201805000-00008"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,4,23]]},"references-count":27,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.1002\/lt.25047","relation":{},"ISSN":["1527-6465","1527-6473"],"issn-type":[{"value":"1527-6465","type":"print"},{"value":"1527-6473","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,4,23]]}}}