{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T13:27:24Z","timestamp":1790083644561,"version":"4.0.1"},"reference-count":36,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2015,2,6]],"date-time":"2015-02-06T00:00:00Z","timestamp":1423180800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2015,4]]},"abstract":"Abstract<\/jats:title>\n \n Objective<\/jats:title>\n \n We compared the effectiveness of lower\u2010dose (\n LD<\/jats:styled-content>\n ) (450\u00a0mg\/day for 6\u00a0months) to standard\u2010dose (\n SD<\/jats:styled-content>\n ) (900\u00a0mg\/day for 6\u00a0months) valganciclovir (\n VGCV<\/jats:styled-content>\n ) prophylaxis for prevention of cytomegalovirus (\n CMV<\/jats:styled-content>\n ) infection and disease in high\u2010risk\n CMV<\/jats:styled-content>\n donor\u2010positive\/recipient\u2010negative (D+\/R\u2212) kidney recipients.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n We performed a single\u2010center, retrospective cohort study, in a 750\u2010bed academic medical center, involving a total of 90 evaluable\n CMV<\/jats:styled-content>\n high\u2010risk kidney recipients. All patients were retrospectively followed from day of transplantation to November 1, 2012, or to the development of\n CMV<\/jats:styled-content>\n infection or disease, death, or loss to follow\u2010up.\n CMV<\/jats:styled-content>\n screening was only done if suggestive symptoms or abnormal laboratory values were present. Our immunosuppressive protocol otherwise did not differ between periods.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n In total, 45 consecutive eligible patients initiated\n SD<\/jats:styled-content>\n prophylaxis in the 22\u00a0months before the institutional protocol change regarding\n CMV<\/jats:styled-content>\n prophylaxis. One patient developed\n CMV<\/jats:styled-content>\n infection in the setting of non\u2010adherence. In the 16\u00a0months after the protocol update, 45 consecutive eligible patients receiving\n LD<\/jats:styled-content>\n prophylaxis were evaluated: 6 developed\n CMV<\/jats:styled-content>\n infection while receiving prophylaxis (\n P<\/jats:italic>\n \u00a0=\u00a00.11). Ganciclovir (\n GCV<\/jats:styled-content>\n )\u2010resistant infection was confirmed in 1 patient in the\n LD<\/jats:styled-content>\n prophylaxis group. Late\u2010onset\n CMV<\/jats:styled-content>\n infection or disease occurred in 11 patients (24%) in the\n SD<\/jats:styled-content>\n group and in 12 patients (27%) in the\n LD<\/jats:styled-content>\n group (\n P<\/jats:italic>\n \u00a0=\u00a00.86). More patients in the\n SD<\/jats:styled-content>\n group developed leukopenia (75% vs. 44%,\n P<\/jats:italic>\n \u00a0<\u00a00.01). During the study period, no significant differences were seen between the groups in mean mg\/kg exposure to rabbit anti\u2010thymocyte globulin induction courses, mean tacrolimus troughs, number of rejection episodes, mean estimated renal function, graft survival, or patient survival. Overall mean follow\u2010up (\u00b1\u00a0standard deviation) was 357\u00a0days (\u00b1\u00a053) in the\n SD<\/jats:styled-content>\n group and 320\u00a0days (\u00b1\u00a0103) in the\n LD<\/jats:styled-content>\n group (\n P<\/jats:italic>\n \u00a0=\u00a00.03).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Breakthrough\n CMV<\/jats:styled-content>\n infection while receiving\n VGCV<\/jats:styled-content>\n prophylaxis occurred more often after the institutional protocol revision to\n LD VGCV<\/jats:styled-content>\n prophylaxis. Given our concern for increased risk of breakthrough infection and\n GCV<\/jats:styled-content>\n resistance when prophylaxis is under\u2010dosed, our institutional protocols were revised back to\n SD<\/jats:styled-content>\n prophylaxis for all\n CMV<\/jats:styled-content>\n D+\/R\u2212 kidney transplant recipients.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/tid.12349","type":"journal-article","created":{"date-parts":[[2015,2,6]],"date-time":"2015-02-06T23:52:59Z","timestamp":1423266779000},"page":"163-173","source":"Crossref","is-referenced-by-count":78,"title":["Increased risk of breakthrough infection among cytomegalovirus donor\u2010positive\/recipient\u2010negative kidney transplant recipients receiving lower\u2010dose valganciclovir prophylaxis"],"prefix":"10.1111","volume":"17","author":[{"given":"D.R.","family":"Stevens","sequence":"first","affiliation":[{"name":"Department of Pharmacy Services Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Sawinski","sequence":"additional","affiliation":[{"name":"Renal Electrolyte and Hypertension Division Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Blumberg","sequence":"additional","affiliation":[{"name":"Infectious Disease Division Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Galanakis","sequence":"additional","affiliation":[{"name":"Philadelphia College of Pharmacy University of the Sciences Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.D.","family":"Bloom","sequence":"additional","affiliation":[{"name":"Renal Electrolyte and Hypertension Division Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Trofe\u2010Clark","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA"},{"name":"Renal Electrolyte and Hypertension Division Department of Medicine Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania 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