{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T03:46:30Z","timestamp":1789271190119,"version":"build-2803163510"},"reference-count":31,"publisher":"The Journal of Health Economics and Outcomes Research","issue":"1","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["jheor.org"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Neutropenia and leukopenia following kidney transplant are linked to poor transplant outcomes. One factor that can contribute to neutropenia or leukopenia following transplant is the use of valganciclovir as a cytomegalovirus prophylaxis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to evaluate post-transplant neutropenia and leukopenia and the associated resource use and costs among kidney transplant recipients receiving valganciclovir prophylaxis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adults receiving kidney transplant with a claim for valganciclovir 30 days post-transplant were included (Merative\u2122 MarketScan\u00ae with Medicare supplemental database, January 2012\u2013March 2021). Incidence of, and risk factors for, neutropenia and leukopenia were assessed 1 year post-transplant. Clinical outcomes, resource use, and costs were assessed through 5 years post-transplant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 3121 and 357 individuals were included for the 1-year and 5-year analyses, respectively. Cumulative incidence of neutropenia or leukopenia 1 year post-transplant was 32.5%. Resource use was greater among patients with myelotoxicities than those without, driven by emergency department and inpatient visits. Among those with resource use, the total unadjusted median cost was greater in patients with vs without myelotoxicities ($82\u202f536 vs $68\u202f652 per patient per year, respectively;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.0001). A greater proportion of those with myelotoxicities experienced clinical complications and resource use 2 to 5 years post-transplant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Of kidney transplant recipients receiving valganciclovir prophylaxis, myelotoxicity claims were present in approximately one-third at 1 year post-transplant. Neutropenia or leukopenia in kidney transplant recipients is associated with high resource use and costs through 5 years post-transplant.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.36469\/001c.159410","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T15:21:25Z","timestamp":1778599285000},"update-policy":"https:\/\/doi.org\/10.36469\/00001","source":"Crossref","is-referenced-by-count":1,"title":["Short and Long-Term Outcomes in Kidney Transplant Recipients with Neutropenia or Leukopenia Following CMV Prophylaxis"],"prefix":"10.36469","volume":"13","author":[{"given":"Vladimir","family":"Turzhitsky","sequence":"first","affiliation":[{"name":"Merck & Co., Inc., Rahway, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinghua","family":"Li","sequence":"additional","affiliation":[{"name":"Formerly of Merck & Co., Inc., Rahway, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Ai","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02891sr49","id-type":"ROR","asserted-by":"publisher"}],"name":"Merck & Co., Inc., Rahway, NJ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murvin","family":"Jootun","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02891sr49","id-type":"ROR","asserted-by":"publisher"}],"name":"Merck & Co., Inc., Rahway, NJ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weijia","family":"Wang","sequence":"additional","affiliation":[{"name":"Formerly of Merck & Co., Inc., Rahway, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Beyer","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02891sr49","id-type":"ROR","asserted-by":"publisher"}],"name":"Merck & Co., Inc., Rahway, NJ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Moise","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02891sr49","id-type":"ROR","asserted-by":"publisher"}],"name":"Merck & Co., Inc., Rahway, NJ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Kolobova","sequence":"additional","affiliation":[{"name":"Formerly of Merck & Co., Inc., Rahway, New Jersey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"22273","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"issue":"7","key":"ref1","doi-asserted-by":"publisher","first-page":"1066","DOI":"10.1097\/TP.0000000000005374","article-title":"The Fourth International Consensus Guidelines on the management of cytomegalovirus in solid organ transplantation","volume":"109","author":"C. N. Kotton","year":"2025","journal-title":"Transplantation"},{"issue":"1","key":"ref2","doi-asserted-by":"publisher","first-page":"e14000","DOI":"10.1111\/tid.14000","article-title":"Burden of neutropenia and leukopenia among adult kidney transplant recipients: a systematic literature review of observational studies","volume":"25","author":"A. D. Raval","year":"2023","journal-title":"Transpl Infect Dis"},{"issue":"suppl 2","key":"ref3","doi-asserted-by":"publisher","first-page":"ofac492.284","DOI":"10.1093\/ofid\/ofac492.284","article-title":"207. Burden of post-transplant neutropenia and leukopenia among kidney transplant recipients: a multi-institutional real-world observational study","volume":"9","author":"A. D. Raval","year":"2022","journal-title":"Open Forum Infect Dis"},{"issue":"10","key":"ref4","doi-asserted-by":"publisher","first-page":"e13058","DOI":"10.1111\/ctr.13058","article-title":"Neutropenia in kidney and liver transplant recipients: risk factors and outcomes","volume":"31","author":"T. A. Mavrakanas","year":"2017","journal-title":"Clin Transplant"},{"issue":"suppl 2","key":"ref5","doi-asserted-by":"publisher","first-page":"ofac492.287","DOI":"10.1093\/ofid\/ofac492.287","article-title":"Neutropenia and associated infectious complications among kidney transplant recipients receiving valganciclovir prophylaxis in the United States: an administrative claims database study","volume":"9","author":"V. Turzhitsky","year":"2022","journal-title":"Open Forum Infect Dis"},{"issue":"2","key":"ref6","doi-asserted-by":"publisher","first-page":"e13467","DOI":"10.1111\/tid.13467","article-title":"A split strategy to prevent cytomegalovirus after kidney transplantation using prophylaxis in serological high-risk patients and a pre-emptive strategy in intermediate-risk patients: combining the best of two options?","volume":"23","author":"R. Hellemans","year":"2021","journal-title":"Transpl Infect Dis"},{"issue":"1","key":"ref7","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1097\/TP.0b013e31821c1e70","article-title":"Poor outcomes associated with neutropenia after kidney transplantation: analysis of United States Renal Data System","volume":"92","author":"F. P. 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Brar","year":"2022","journal-title":"Clin Transplant"},{"issue":"2","key":"ref11","doi-asserted-by":"publisher","first-page":"e13483","DOI":"10.1111\/tid.13483","article-title":"Epidemiology, risk factors, and outcomes associated with cytomegalovirus in adult kidney transplant recipients: a systematic literature review of real\u2010world evidence","volume":"23","author":"A. D. Raval","year":"2021","journal-title":"Transpl Infect Dis"},{"issue":"9","key":"ref12","doi-asserted-by":"publisher","first-page":"e13512","DOI":"10.1111\/ctr.13512","article-title":"Cytomegalovirus in solid organ transplant recipients-guidelines of the American Society of Transplantation Infectious Diseases Community of Practice","volume":"33","author":"R. R. 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Current Series US Medical Care, 1982-84=100 - CUUR0000SAM, Medical care in the US city average, all urban consumers, not seasonally adjusted","author":"Bureau of Labor Statistics"},{"key":"ref16","article-title":"Consumer Price Index (CPI) for prescription drugs. Not seasonally adjusted, U.S. city average","author":"Bureau of Labor Statistics"},{"issue":"3","key":"ref17","doi-asserted-by":"publisher","first-page":"e13541","DOI":"10.1111\/tid.13541","article-title":"Among CMV-positive renal transplant patients receiving non-T-cell depleting induction, the absence of CMV disease prevention is a safe strategy: a retrospective cohort of 372 patients","volume":"23","author":"H. Boulay","year":"2021","journal-title":"Transpl Infect Dis"},{"key":"ref18","article-title":"FR\u2212PO829: Healthcare utilization and costs associated with neutropenia\/leukopenia in kidney transplant recipients receiving valganciclovir prophylaxis: an administrative claims database study","author":"V. Turzhitsky","year":"2022"},{"key":"ref19","article-title":"FR\u2212PO849: Health care resource utilization associated with post-transplant neutropenia and leukopenia among kidney transplant recipients: a real-world evidence study","author":"A. Raval","year":"2022"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"10332","DOI":"10.3389\/ti.2022.10332","article-title":"Cytomegalovirus management in solid organ transplant recipients: a pre-COVID-19 survey from the working group of the European Society for Organ Transplantation","volume":"35","author":"P. A. Grossi","year":"2022","journal-title":"Transpl Int"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1694","DOI":"10.1007\/s00125-020-05217-1","article-title":"Real-world evidence: The devil is in the detail","volume":"63","author":"M. 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