Body Surface Area Compared to Body Weight Dosing of Valganciclovir Is Associated With Increased Toxicity in Pediatric Solid Organ Transplantation Recipients

Authors

• Salih Demirhan
• Flor M Munoz
• Kristen G Valencia Deray
• Claire E Bocchini
• Lara Danziger-Isakov
• Samantha Blum
• Tanvi S Sharma
• Gilad Sherman
• Juri Boguniewicz
• Samantha Bacon
• Monica I Ardura
• Gabriela M Maron
• Jose Ferrolino
• Marc Foca
• Betsy C Herold

Language

English

Publication Date

12-1-2023

Journal

American Journal of Transplantation

DOI

10.1016/j.ajt.2023.07.013

PMID

37499799

PubMedCentral® Posted Date

12-23-2023

Abstract

Optimal dosing of valganciclovir (VGCV) for cytomegalovirus (CMV) prevention in pediatric solid organ transplantation recipients (SOTR) is controversial. Dosing calculated based on body surface area (BSA) and creatinine clearance is recommended but simplified body weight (BW) dosing is often prescribed. We conducted a retrospective 6-center study to compare safety and efficacy of these strategies in the first-year posttransplant There were 100 (24.2%) pediatric SOTR treated with BSA and 312 (75.7%) with BW dosing. CMV DNAemia was documented in 31.0% vs 23.4% (P = .1) at any time during the first year and breakthrough DNAemia in 16% vs 12.2% (P = .3) of pediatric SOTR receiving BSA vs BW dosing, respectively. However, neutropenia (50% vs 29.3%, P < .001), lymphopenia (51% vs 15.0%, P < .001), and acute kidney injury causing treatment modification (8.0% vs 1.8%, P < .001) were documented more frequently during prophylaxis in pediatric SOTR receiving BSA vs BW dosing. The adjusted odds ratio of VGCV-attributed toxicities comparing BSA and BW dosing was 2.3 (95% confidence interval [CI], 1.4-3.7] for neutropenia, 7.0 (95% CI, 3.9-12.4) for lymphopenia, and 4.6 (95% CI, 2.2-9.3) for premature discontinuation or dose reduction of VGCV, respectively. Results demonstrate that BW dosing is associated with significantly less toxicity without any increase in CMV DNAemia.

Keywords

Child, Humans, Valganciclovir, Antiviral Agents, Cytomegalovirus Infections, Body Surface Area, Retrospective Studies, Cytomegalovirus, Neutropenia, Organ Transplantation, Body Weight, Lymphopenia, Ganciclovir, body surface area, body weight, cytomegalovirus, lymphopenia, neutropenia, solid organ transplantation, valganciclovir

Published Open-Access

yes

Recommended Citation

Demirhan, Salih; Munoz, Flor M; Valencia Deray, Kristen G; et al., "Body Surface Area Compared to Body Weight Dosing of Valganciclovir Is Associated With Increased Toxicity in Pediatric Solid Organ Transplantation Recipients" (2023). Faculty, Staff and Students Publications. 7676.
https://digitalcommons.library.tmc.edu/baylor_docs/7676