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Abstract: FR-PO866

Efficacy and Safety According to Dose of Valganciclovir for Cytomegalovirus (CMV) Prophylaxis in Transplantation: Network Meta-Analysis Using Recent Data

Session Information

Category: Transplantation

  • 1802 Transplantation: Clinical

Authors

  • Lee, Jin ho, Bong Seng Memorial Hospital, Busan, Korea (the Republic of)
  • Hwang, Seon Deok, Inha University College of Medicine, Incheon, Korea (the Republic of)
  • Lee, Seoung Woo, Inha University Hospital, Inchon City, Korea (the Republic of)
  • Park, Woo Yeong, Dongsan Medical Center, Daegu, Korea (the Republic of)
  • Kim, Jeong Ho, Daejeon St. Mary's Hospital, Daejeon, Korea (the Republic of)
  • Kim, Hee yeoun, Bongseng hospital, Busan, Korea (the Republic of)
  • Kim, Seong min, Dongrae Bongseng Hospital, Busan, Korea (the Republic of)
  • Oh, Joon Seok, Bong Seng Hospital, Korea, Dong-gu, Busan, Korea (the Republic of)
  • Lee, Dongyeol, Bong Seng Memorial Hospital, Busan, Korea (the Republic of)
  • Sin, Yong hun, Bong Seng Hospital, Busan, Korea (the Republic of)
  • Kim, Joong Kyung, Bong Seng Memorial Hospital, Busan, Korea (the Republic of)
Background

Valgancivlovir is used to prevent post-transplant CMV infection among kidney transplantation patients. However, the dose of drug being used still remains controversial since the continuous use of such drug decrease kidney functions and induces leukopenia in some of the cases. Accordingly, the purpose is to measure the appropriate dose of the drug required for preventing CMV using network Meta analysis

Methods

We searched the Cochrane Central Register, OVID MEDLINE, EMBASE, and Pubmed until April 15, 2017. We reviewed the reference lists of relevant reviews, registered trials, and relevant conference proceedings. Definition of low dose valganciclovir group is 450mg and standard dose one is 900mg. Studies evaluating among valganciclovir 900 mg, 450 mg and controls were evaluated. We performed direct and indirect network meta-analysis using Bayesian models and generated rankings of the different dose of valgaciclovir agents by generation mixed treatment comparison (GeMTC).

Results

Twenty-four studies involving 3,730 participants were eligible. As a result of analyzing among three groups, following completion of the research, the analysis revealed that the glomerular filtration rate, graft loss, tacrolimus level, antibody mediated rejection, fungal, and Candida infection rates were not different among groups. Compared with control, there was no difference between low dose 0.79 [95% Crl, 0.50-1.40] and standard dose 1.0 [95% Crl, 0.61-1.60] groups when CMV incidence was compared. In the Rank probabilities table, the best order for lowering the CMV event was as high as dose of 450mg (71.1%). Incidence of leukopenia showed a significant difference, but there was no statistical significance in the low dose group 1.5 [95% Crl, 0.99-2.20] compared with the control group, but 4.3 times higher in the high dose group 4.3 [95% Crl, 2.69-7.10 ], which was 2.9 times higher in the low dose group and the high dose group 2.9 [95% Crl, 1.88 -4.67].

Conclusion

The use of valganciclovir did not show any difference in other side effects, but the use of low doses of leukopenia significantly reduced side effects. The incidence of CMV was not different among the three groups, but the tendency was also decreased at low dose.