Disparities in Access to Valganciclovir Cytomegalovirus Prophylaxis in High-Risk African American Kidney Transplant Patients

Transpl Infect Dis. 2025 Mar-Apr;27(2):e14416. doi: 10.1111/tid.14416. Epub 2024 Dec 18.

Abstract

Background: While access and outcomes disparities for African American (AA) kidney transplant recipients are documented, there are limited studies assessing medication access disparities in transplantation. Cytomegalovirus (CMV) causes severe complications for transplant recipients, and we aimed to understand differences in access to CMV prophylaxis valganciclovir and its impact on CMV infection rates in AA transplant recipients.

Methods: This single-center, retrospective longitudinal cohort study examined high-risk (CMV serostatus D+/R-) adult kidney transplant recipients between June 1, 2010, and May 31, 202, through EMR abstraction. Standard univariate comparative statistics were employed alongside binary logistic regression for multivariable modeling.

Results: During the 10 year period, 418 kidney transplant recipients were included, with 179 (42.8%) identified as AA and 239 as non-AA. There were significant differences in mean age (p = 0.001) and private versus Medicaid insurance status (p < 0.001). AAs experienced higher death-censored graft loss rates (10.6% AA vs. 5.0% non-AA, p = 0.031). CMV infection rate, opportunistic infection rate, leukopenia incidence, and death did not differ significantly between AA and non-AA patients. AA patients were 42% less likely to receive valganciclovir out-of-pocket cost assistance compared to non-AA patients (OR 0.58, [0.379-0.892], p = 0.013). When incorporating age, Medicaid status, and donor marginality in a multivariable model, the impact of AA race on utilizing assistance programs became statistically non-significant (OR 0.70, [0.448-1.094], p = 0.118).

Conclusions: AAs were significantly less likely to leverage assistance programs or utilize personal resources to access valganciclovir. This disparity was partially explained by age, insurance status, and donor type. Despite this, CMV infection rates were similar between AA and non-AA cohorts.

Keywords: cytomegalovirus; disparities; equity; prophylaxis; renal transplantation; valganciclovir.

MeSH terms

  • Adult
  • Aged
  • Antiviral Agents* / therapeutic use
  • Black or African American* / statistics & numerical data
  • Cytomegalovirus
  • Cytomegalovirus Infections* / epidemiology
  • Cytomegalovirus Infections* / ethnology
  • Cytomegalovirus Infections* / prevention & control
  • Cytomegalovirus Infections* / virology
  • Female
  • Ganciclovir* / analogs & derivatives
  • Ganciclovir* / therapeutic use
  • Health Services Accessibility* / statistics & numerical data
  • Healthcare Disparities* / statistics & numerical data
  • Humans
  • Kidney Transplantation* / adverse effects
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Racial Groups / statistics & numerical data
  • Retrospective Studies
  • Risk Factors
  • Transplant Recipients / statistics & numerical data
  • United States / epidemiology
  • Valganciclovir* / therapeutic use

Substances

  • Antiviral Agents
  • Ganciclovir
  • Valganciclovir

Grants and funding