Resource utilization of cytomegalovirus immune globulin in prevention and treatment of cytomegalovirus infection in pediatric heart transplantation

Alfred Asante-Korang, Jennifer Carapellucci, Diane Krasnopero, Brian Brown, Amy Kiskaddon, Bethany Wisotzkey, Gabriella Blyumin, David M. Berman, Katie Namtu

Research output: Contribution to journalArticlepeer-review

Abstract

Background: There is debate whether cytomegalovirus immunoglobulin (CMV-Ig) is also needed for CMV prevention in heart transplant recipients in the era of good anti-viral drugs. Methods: We conducted a cost-savings quality initiative on CMV-Ig eventually leading to discontinuation of routine use of CMV-Ig for CMV prevention. Subsequently, a retrospective cohort study was conducted, comparing patients in cohort I (CMV-Ig plus anti-viral drugs, 2013-2015) to cohort II (anti-virals alone, 2015-2017). The medication acquisition costs and outcomes of CMV infection were assessed. Results: There were 39 total patients: 22/39(56%) in cohort I, with mean follow-up of 35.14 ± 17.38 months and 17/39(44%) in cohort II, mean follow-up of 19.12 ± 7.08 months. In cohort I, 5/22(22.7%) patients died from causes unrelated to CMV and 0/17 in cohort II died. There were 5/22(22.7%) patients in cohort I, and 2/17(9%) patients in cohort II that developed CMV infection (P =.508). Freedom from rejection was 81.8% (18/22) in cohort I, and 71% (12/17) in cohort II (P =.46), and 100% for allograft vasculopathy. There was significant reduction in medication acquisition cost following the protocol change of $260 839 or $15 343 per patient. Conclusion: Our study demonstrated an acquisition cost savings with similar clinical outcomes utilizing anti-viral CMV prophylaxis alone vs anti-viral prophylaxis plus CMV-Ig.

Original languageEnglish (US)
Article numbere13750
JournalClinical Transplantation
Volume33
Issue number12
DOIs
StatePublished - Dec 1 2019
Externally publishedYes

Keywords

  • cytomegalovirus (CMV)
  • cytomegalovirus immunoglobulin (CMV-Ig)
  • ganciclovir
  • heart disease: heart transplant
  • infection and infectious agents
  • pediatric
  • valganciclovir

ASJC Scopus subject areas

  • Transplantation

Fingerprint Dive into the research topics of 'Resource utilization of cytomegalovirus immune globulin in prevention and treatment of cytomegalovirus infection in pediatric heart transplantation'. Together they form a unique fingerprint.

Cite this