Ganciclovir therapy of severe cytomegalovirus infections in solid-organ transplant recipients.
The clinical and virologic efficacy of ganciclovir (9-[1,3-dihydroxy-2-propoxymethyl]guanine) in the treatment of severe CMV infections in solid organ transplant recipients was investigated. Twelve patients (9 liver and 3 kidney transplant recipients) with CMV retinitis, esophagitis, hepatitis, or pneumonia received ganciclovir at a dose of 0.75-7.5 mg/kg/day for 10-30 days (mean duration 17 days). Clinical stabilization or improvement occurred in 8 patients (67%). Serial liver biopsies in 6 liver allograft recipients with CMV hepatitis demonstrated substantial histologic improvement on treatment. Of 6 patients with CMV pneumonia, 4 (67%) recovered and survived. Cultures of blood and other sites became negative in 9 patients (75%). Three patients (25%) had recurrent viral shedding after treatment, but none of these relapsed with invasive infections. Mild neutropenia was the only side effect encountered but was frequent (67%). The overall survival rate was 50%. Ganciclovir is effective in reducing CMV shedding in solid organ transplant recipients and is well tolerated. Our experience suggests a clinical benefit as well in patients with severe, invasive CMV disease. Relapse, in contrast to patients with the acquired immunodeficiency syndrome, is infrequent.
Harbison
M A
MA
Department of Medicine, New England Deaconess Hospital, Boston, Massachusetts 02215.
De Girolami
P C
PC
Jenkins
R L
RL
Hammer
S M
SM
D000212:Acyclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use; D001707:Biopsy, Needle; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000382:microbiology; D015774:Ganciclovir; D006801:Humans; D016030:Kidney Transplantation; D008099:Liver / Q000382:microbiology; D016031:Liver Transplantation; D009894:Opportunistic Infections / Q000188:drug therapy*
D015774:Ganciclovir; D000212:Acyclovir