title: Allograft rejection predicts the occurrence of late-onset cytomegalovirus (CMV) disease among CMV-mismatched solid organ transplant patients receiving prophylaxis with oral ganciclovir.
abstract: The natural history of cytomegalovirus (CMV) disease associated with solid organ transplantation has been modified as a result of the widespread use of antiviral prophylaxis. Anecdotal reports have indicated a reduction of CMV disease at the expense of its later occurrence after completion of ganciclovir prophylaxis. The present study investigated the occurrence of CMV disease and its risk factors among 37 liver and kidney transplant recipients with CMV D+/R- status who received oral ganciclovir during the first 100 days posttransplantation. CMV disease occurred in 9 patients (24.3%) at a median of 144 days posttransplantation (range, 95-190 days). Allograft rejection was found to be strongly associated with the occurrence of late-onset CMV disease (risk ratio, 6.6; 95% confidence interval, 1.4-32.1; P=.02). Thus, CMV D+/R- solid organ transplant recipients receiving 3 months of oral ganciclovir who develop allograft rejection during the period of antiviral prophylaxis may benefit from extended and/or enhanced antiviral prophylaxis to prevent late-onset CMV disease.
authors.affiliation: Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA. razonable.raymund@mayo.edu
authors.forename: R R
authors.initials: RR
authors.lastname: Razonable
authors.forename: A
authors.initials: A
authors.lastname: Rivero
authors.forename: A
authors.initials: A
authors.lastname: Rodriguez
authors.forename: J
authors.initials: J
authors.lastname: Wilson
authors.forename: J
authors.initials: J
authors.lastname: Daniels
authors.forename: G
authors.initials: G
authors.lastname: Jenkins
authors.forename: T
authors.initials: T
authors.lastname: Larson
authors.forename: W C
authors.initials: WC
authors.lastname: Hellinger
authors.forename: J R
authors.initials: JR
authors.lastname: Spivey
authors.forename: C V
authors.initials: CV
authors.lastname: Paya
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D018572:Disease-Free Survival; D005260:Female; D005544:Forecasting; D015774:Ganciclovir / Q000008:administration & dosage / Q000627:therapeutic use*; D006084:Graft Rejection / Q000150:complications* / Q000276:immunology; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects; D007700:Kinetics; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects*; D012307:Risk Factors
chemical_list: D000914:Antibodies, Viral; D000998:Antiviral Agents; D015774:Ganciclovir