A national survey of valganciclovir dosing strategies in pediatric organ transplant recipients

Clin Transplant. 2018 Sep;32(9):e13369. doi: 10.1111/ctr.13369. Epub 2018 Aug 20.

Abstract

Purpose: Data remain limited on the most appropriate valganciclovir (VGCV) dosing strategy for cytomegalovirus (CMV) prophylaxis and treatment in pediatric organ transplant recipients. Therefore, the objective of this study was to describe methods used to calculate VGCV dosing among pediatric transplant centers.

Methods: A survey of pharmacists was conducted to assess VGCV dosing strategies for CMV prophylaxis and treatment among pediatric organ transplant centers in the U.S.

Findings: Of 54 centers that perform pediatric organ transplants, 22 (40.7%) centers responded to the survey. Fourteen centers (53.8%) utilize the Food and Drug Administration (FDA) recommended VGCV dosing strategy of 7 × body surface area (BSA) × creatinine clearance (CrCl) for CMV prophylaxis. Other dosing strategies reported included weight based and 520 mg/m2 × BSA per day. Dosing strategies of VGCV for the treatment of CMV also differed across centers, with a majority (43.5%) using 7 × BSA × CrCl twice daily.

Conclusion: Less than two-thirds of centers utilize the FDA-approved daily dosing regimen with various methods of CrCl calculation and serum creatinine assay measurements used. More retrospective and prospective studies with clinical outcomes associated with VCGV dosing strategies are warranted to determine the most appropriate prophylaxis and treatment strategies for CMV.

Keywords: antibiotic: antiviral-ganciclovir/valganciclovir; complication: infectious, infection and infectious agents, viral, infection and infectious agents; viral: cytomegalovirus.

MeSH terms

  • Antiviral Agents / therapeutic use*
  • Cytomegalovirus / drug effects*
  • Cytomegalovirus Infections / drug therapy*
  • Cytomegalovirus Infections / epidemiology
  • Cytomegalovirus Infections / virology
  • Dose-Response Relationship, Drug
  • Humans
  • Organ Transplantation / adverse effects*
  • Prognosis
  • Surveys and Questionnaires
  • Transplant Recipients / statistics & numerical data*
  • Valganciclovir / therapeutic use*

Substances

  • Antiviral Agents
  • Valganciclovir