Table 3.
Duration of prophylaxis and provision of appropriate prophylaxis by organ group and risk status pre-and post-intervention
| Transplant Type and Risk | Median duration of prophylaxis (days) (Q1,Q3) |
Appropriate prophylaxis (appropriate agent for risk status) n (%) |
Appropriate prophylaxis (appropriate duration and dose) n (%) |
||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Pre | Post | p-value* | Pre | Post | p-value** | Pre | Post | p-value** | |||||
| Yes | No | Yes | No | Yes | No | Yes | No | ||||||
| Kidney | |||||||||||||
| High | 363(355,368) | 365(354,379) | 0.45 | 24(100%) | 0(0%) | 19(100%) | 0(0%) | -- | 1(4%) | 23(96%)† | 0(0%) | 19(100%)† | 0.99 |
| Intermediate | 365(364,378) | 365(360,371) | 0.39 | 18(100%) | 0(0%) | 14(100%) | 0(0%) | -- | 0(0%) | 18(100%)† | 0(0%) | 14(100%)† | -- |
| Low | 371(364,522) | 367(365,369) | 0.54 | 0(0%) | 26(100%)† | 1(9%) | 10(91%)† | 0.30 | -- | -- | -- | -- | -- |
| Liver | |||||||||||||
| High | 90(84,136) | 183(173,195) | <0.01 | 9(100%) | 0(0%) | 9(100%) | 0(0%) | -- | 1(11%) | 8(89%)‡ | 8(89%) | 1(11%)‡ | <0.01 |
| Intermediate | 89(84,125) | 178(66,183) | 0.62 | 8(89%) | 1(11%)‡ | 7(100%) | 0(0%) | 0.99 | 7(78%) | 2(22%)‡ | 2(29%) | 5(71%)‡ | 0.13 |
| Low | -- | -- | -- | 0(0%) | 11(100%)‡ | 4(57%) | 3(43%)‡ | 0.01 | -- | -- | -- | -- | |
| Lung | |||||||||||||
| High | 396(299,504) | 242 | 0.40 | 4(100%) | 0(0%) | 2(100%) | 0(0%) | -- | 3(75%) | 1(25%)Ψ | 2(100%) | 0(0%) | 0.99 |
| Intermediate | 550(294,842) | 395(201,508) | 1.00 | 4(100%) | 0(0%) | 8(89%) | 1(11%)Ψ | 0.99 | 2(50%) | 2(50%)Ψ | 3(33%) | 6(67%)Ψ | 0.99 |
| Low | -- | -- | -- | 1(25%) | 3(75%)Ψ | 1(100%) | 0(0%) | 0.40 | -- | -- | -- | -- | -- |
| Heart | |||||||||||||
| High | 90(86–118) | 125(86,251) | 1.00 | 11(100%) | 0(0%) | 9(100%) | 0(0%) | -- | 2(18%) | 9(82%)κ | 3(33%) | 6(67%)κ | 0.62 |
| Intermediate | 88(81–100) | 147(95,189) | 0.24 | 5(100%) | 0(0%) | 6(100%) | 0(0%) | -- | 5(100%) | 0(0%) | 3(50%) | 3(50%)κ | 0.18 |
| Low | -- | -- | -- | 4(50%) | 4(50%)κ | 11(92%) | 1(8%)κ | 0.11 | -- | -- | -- | -- | -- |
| Multivisceral | |||||||||||||
| High | 1376 | 292 | 0.33 | 1(100%) | 0(0%) | 2(100%) | 0(0%) | -- | 0(0%) | 1(100%)β | 1(50%) | 1(50%)β | 0.99 |
| Intermediate | 509(227,1281) | 687 | 1.00 | 5(100%) | 0(0%) | 1(100%) | 0(0%) | -- | 1(20%) | 4(80%)β | 0(0%) | 1(100%)β | 0.99 |
| Low | -- | -- | -- | 0(0%) | 2(100%)β | 0(0%) | 0(0%) | -- | -- | -- | -- | -- | -- |
| Non-kidney grafts | -- | -- | -- | 52(71%) | 21(29%) | 60(92%) | 5(8%) | <0.01 | 21(43%) | 27(56%) | 22(49%) | 23(51%) | 0.62 |
| High | 97(90,277) | 182(136,234) | 0.03 | 25(100%) | 0(0%) | 22(100%) | 0(0%) | -- | 6(24%) | 19(76%) | 14(64%) | 8(36%) | <0.01 |
| Intermediate | 115(87,405) | 182(95,380) | 0.37 | 22(96%) | 1(4%) | 22(96%) | 1(4%) | 0.99 | 15(65%) | 8(35%) | 8(35%) | 15(65%) | 0.04 |
| Low | -- | -- | -- | 5(20%) | 20(80%) | 16(80%) | 4(20%) | <0.01 | -- | -- | -- | -- | -- |
p-value from independent samples median test;
p-value from fisher’s exact/chi-square test testing for difference in categorical variables pre- and post-intervention.
Kidney: All low risk recipients received 12 months of valganciclovir prophylaxis when none was recommended in the standardized protocols; High and intermediate risk recipients received longer than recommended duration of prophylaxis
Liver: 7 out of 8 high risk patients who received inappropriate duration of prophylaxis in the pre-intervention period received shorter than recommended duration while 1 high-risk patient in the post-intervention period received longer than recommended duration; 1 intermediate risk patient in the pre-intervention period received inappropriate agent (acyclovir) while 1 received longer than necessary prophylaxis. 4 out of 5 intermediate risk patients who received inappropriate duration of prophylaxis in the post-intervention period received longer than recommended duration while 1 received shorter than recommended duration. 11 low risk recipients in the pre-intervention period received acyclovir prophylaxis while 3 out of 7 low risk recipients in the post-intervention period received acyclovir prophylaxis when none was recommended.
Lung: 1 high risk patient and 2 intermediate risk patients who received inappropriate duration of prophylaxis in the pre-intervention period received longer than recommended duration. 1 intermediate risk patient in the post-intervention period received acyclovir instead of valganciclovir prophylaxis. 4 out of 6 intermediate risk patients who received inappropriate duration of prophylaxis in the post-intervention period received longer than necessary prophylaxis. 3 out of 4 low risk patients in the pre-intervention period received valganciclovir prophylaxis when none was recommended.
Heart: 7 out of 9 high risk patients who received inappropriate duration of prophylaxis in the pre-intervention period and 4 out of 6 high risk patients who received inappropriate duration of prophylaxis in the post-intervention period received shorter than recommended duration. All 3 intermediate risk patients who received inappropriate duration of prophylaxis in the post-intervention period received longer than recommended duration. 4 out of 8 low risk patients in the pre-intervention period and 1 out of 12 low risk patients in the post-intervention period received prophylaxis when none was recommended.
Multivisceral: Both low risk patients in the pre-intervention period received valganciclovir prophylaxis when none was recommended. All high and intermediate risk patients who had received inappropriate duration of prophylaxis in both periods received longer than recommended duration.