title: Impact of ganciclovir prophylaxis on cytomegalovirus infection in recipients of cadaveric renal allografts.
abstract: Cytomegalovirus (CMV) infection is a major cause of morbidity and occasionally of mortality in immunosuppressed allograft recipients. At the University of Cincinnati Medical Center, ganciclovir has been administered for the prevention of CMV infection since July 1992. Forty-six recipients of cadaveric renal allografts (Group I) received ganciclovir at a dose of 2.5 or 5 mg/kg/day (adjusted for renal function) for 14-21 days, during induction treatment and during antirejection treatment with monoclonal or polyclonal antilymphocyte preparations. In this retrospective study, these 46 patients were compared with 77 recipients of cadaveric renal allografts transplanted prior to July 1992 (Group II) for the prevalence, severity and time of CMV occurrence after transplantation. CMV diagnosis was based on clinical evaluation and was confirmed by blood cultures, CMV antigen immunofluorescence assay and/or histology. Patients were stratified according to CMV serology (+) or (-) in donor and recipient. CMV infection developed in 16 of 46 (35%) patients in Group I vs. 27 of 77 (35%) patients in Group II (p = 0.97). A total of 25 episodes of CMV infection occurred in Group I compared to 44 in Group II (p = 0.76). CMV infection was diagnosed an average of 97.4 days after transplant in Group I compared to 48.3 days in Group II (p = 0.0003). Tissue-invasive CMV infection occurred in 3 patients in Group I (19%) vs. 12 in Group II (44%) (p = 0.5). In conclusion, ganciclovir prophylaxis resulted in a delayed onset of clinical CMV infection with a trend towards less severe infection in patients treated with antilymphocyte antibody preparations.
authors.affiliation: Department of Internal Medicine, University of Cincinnati Medical Center, Ohio 45267-0585, USA.
authors.forename: V
authors.initials: V
authors.lastname: Ram Peddi
authors.forename: S
authors.initials: S
authors.lastname: Hariharan
authors.forename: T J
authors.initials: TJ
authors.lastname: Schroeder
authors.forename: M R
authors.initials: MR
authors.lastname: First
mesh_terms: D000328:Adult; D000961:Antilymphocyte Serum / Q000494:pharmacology; D000998:Antiviral Agents / Q000008:administration & dosage*; D002102:Cadaver; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage*; D006084:Graft Rejection / Q000276:immunology / Q000628:therapy; D006801:Humans; D007165:Immunosuppression Therapy; D015994:Incidence; D016030:Kidney Transplantation / Q000276:immunology; D008297:Male; D015995:Prevalence; D051437:Renal Insufficiency / Q000601:surgery / Q000821:virology*; D012189:Retrospective Studies; D014184:Transplantation, Homologous
chemical_list: D000961:Antilymphocyte Serum; D000998:Antiviral Agents; D015774:Ganciclovir