High-dose acyclovir prophylaxis reduces cytomegalovirus disease in liver transplant patients.
Cytomegalovirus (CMV) is still a major pathogen in liver transplantation (LTX). The clinical efficacy of prophylactic high-dose acyclovir therapy (800 mg qid) was assessed for the prevention of CMV infection and disease in liver recipients. Fifty-five patients were enrolled in a prospective, randomised, double-blind and placebo-controlled trial; 28 on acyclovir vs. 27 on placebo. The therapy was given for 12 weeks. The patients were followed for 24 weeks. CMV infection was diagnosed in 60% (16 on acyclovir, 17 on placebo) and CMV disease developed in 38% (7 on acyclovir, 14 on placebo) of the patients. The total mortality was 27% (6 on acyclovir, 10 on placebo). Acyclovir delayed 32% of the CMV infections and prevented 59% of the CMV disease cases which occurred in the placebo cohort. The time to CMV disease was significantly prolonged in patients on acyclovir as compared to patients on placebo (P=0.013). Adverse events included neurotoxicity which occurred in 5 cases in the acyclovir, but none in the placebo arm, and nephrotoxicity which was detected in 6 patients in the acyclovir and 5 in the placebo arm, respectively. We conclude that acyclovir prophylaxis significantly reduced the incidence of CMV disease, and delayed the onset of CMV infection in liver transplant patients.
Barkholt
L
L
Division of Transplantation Surgery, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden. lisbeth.barkholt@impi.ki.se
Lewensohn-Fuchs
I
I
Ericzon
B G
BG
Tydén
G
G
Andersson
J
J
D000212:Acyclovir / Q000008:administration & dosage / Q000627:therapeutic use*; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D006085:Graft Survival; D006561:Herpes Simplex / Q000453:epidemiology; D006801:Humans; D007275:Injections, Intravenous; D016031:Liver Transplantation / Q000502:physiology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010919:Placebos; D011183:Postoperative Complications / Q000517:prevention & control*; D016016:Proportional Hazards Models; D013997:Time Factors
D000998:Antiviral Agents; D010919:Placebos; D003404:Creatinine; D000212:Acyclovir