431Incidence, Burden and Cost Analysis of CMV Reactivation after Use of Anti-Thymocyte Globulin in Resource-Limited Setting

Background. Cytomegalovirus (CMV) causes a significant morbidity and mortality after kidney transplantation (KT), especially after anti-thymocyte globulin (ATG) use. Despite recommendation, CMV prophylaxis post KT is not always feasible. We aimed to study the incidence, consequences and cost analysis of CMV disease/infection (called reactivation hereafter), after ATG use among KT patients (pts) in resource limited setting. Methods. Retrospective cohort study of ATG treated KT pts during 2010-2013 at Ramathibodi hospital, Bangkok, Thailand. Data were collected from medical records including type of KT, maintenance immunosuppression, CMV prophylaxis, CMV reactivation, co-infections, cost of inpatient and outpatient post KT and outcome. Results. Of 30 pts 53%, were female. Pts’ median age was 43 (25-68) years old. All were CMV D + /R+. Most (53%) had living related KT. Majority (77%) received ATG as an induction therapy. Combination of mycofenolate/tacrolimus/ prednisolone was used in 73%. Rejection occurred in 13 (43%) pts, most (61%) of which were antibody mediated during early post KT. CMV prophylaxis was given only during inpatient stay in 29 (90%) pts with median duration of 13(2-55) days. Outpatient CMV prophylaxis with valganciclovir at a mimimum of 100 day was given in 3 (10%) pts. Incidence of CMV reactivation was 43%, with a median onset of 90 (23-1007) days after KT. None occurred among those receiving outpatient CMV prophylaxis. CMV reactivation associated with significant higher risk of co-infections (P = 0.027). Median duration of follow up was 542 (134-1,348) days. Graft loss was 17%. Survival rate was 97%. Compared with outpatient CMV prophylaxis, the cost of treatment for CMV reactivation was significantly higher for both inpatient cost (P = 0.021), and total cost post KT (P = 0.035). Conclusion. Incidence of CMV reactivation post KT with ATG use (D + /R+) was high without adequate CMV prophylaxis and viral load monitoring. CMV reactivation associated with significant higher risk of co-infections. Cost analysis showed significant higher cost of treatment for CMV reactivation. CMV prophylaxis should be given in ATG treated pts in resource-limited settings. Disclosures. All authors: No reported disclosures.