title: Eradication of cytomegalovirus reactivation disease using high-dose acyclovir and targeted intravenous ganciclovir in kidney and kidney/pancreas transplantation.
abstract: BACKGROUND
  The attack rate of cytomegalovirus (CMV) is over 50% in solid organ transplant recipients at risk for primary CMV infection and in those receiving antilymphocyte antibody therapy. Various CMV prophylaxis regimens over the last few years have reduced the attack rate to around 20% overall.
  
  
  METHODS
  We report our results using high-dose acyclovir for 3 months after transplant, with targeted intravenous ganciclovir for the duration of any antilymphocyte antibody therapy, in our kidney and simultaneous pancreas/kidney transplant recipients. Records of 109 consecutive patients over a 2-year period were reviewed.
  
  
  RESULTS
  Six cases of CMV disease were identified. Five cases occurred in 21 patients at risk for primary CMV disease (24%), whereas only one case occurred in 73 patients at risk for CMV reactivation (1.4%).
  
  
  CONCLUSIONS
  We conclude that high-dose acyclovir and targeted ganciclovir is excellent prophylaxis against CMV reactivation in kidney and simultaneous pancreas/kidney transplantation.
authors.affiliation: Multi-Organ Transplant Center, Stanford University Medical Center, California 94305, USA.
authors.forename: G K
authors.initials: GK
authors.lastname: Shen
authors.forename: E J
authors.initials: EJ
authors.lastname: Alfrey
authors.forename: C L
authors.initials: CL
authors.lastname: Knoppel
authors.forename: D C
authors.initials: DC
authors.lastname: Dafoe
authors.forename: J D
authors.initials: JD
authors.lastname: Scandling
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use*; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D015774:Ganciclovir / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007275:Injections, Intravenous; D016030:Kidney Transplantation / Q000502:physiology; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000502:physiology; D011183:Postoperative Complications / Q000517:prevention & control; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000961:Antilymphocyte Serum; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D003404:Creatinine; D015774:Ganciclovir; D000212:Acyclovir