Pre-emptive oral ganciclovir can reduce the risk of cytomegalovirus disease in liver transplant recipients.
A cohort of 65 liver transplant recipients was prospectively monitored with qualitative polymerase chain reaction (PCR) in plasma. The first 25 patients did not receive prophylaxis. From a consecutive group of 40 recipients, 11 high-risk patients donor CMV-seropositive/receptor CMV-seronegative (D+/R-), persistent CMV replication) received pre-emptive oral ganciclovir (1000 mg three times daily), when a marker of risk was identified, until day 90. The overall incidence of cytomegalovirus (CMV) disease at six months was 20% (five of 25 patients) in the non-prophylaxis group and 2.5% (one of 40 patients) in the group treated with pre-emptive oral ganciclovir (relative risk, 0.11; 95% confidence interval; 0.01-0.96; P = 0.04). The PCR sensitivity for detecting CMV disease was 80%, the specificity was 90%, and the positive and negative predictive values were 66% and 95%, respectively. Adverse events, graft rejection and survival were similar between groups. We conclude that pre-emptive oral ganciclovir in high-risk patients can reduce the risk of CMV disease.
Torre-Cisneros
J
J
Section of Infectious Diseases, Liver Transplantation Unit and Service of Immunology, Hospital Universitario Reina Sofia, Cordoba, Spain. jtorrec@meditex.es
Madueño
J A
JA
Herrero
C
C
de la Mata
M
M
Gonzalez
R
R
Rivero
A
A
Miño
G
G
Sánchez-Guijo
P
P
D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015331:Cohort Studies; D003587:Cytomegalovirus / Q000235:genetics / Q000254:growth & development*; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D004279:DNA, Viral / Q000097:blood; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity
D000998:Antiviral Agents; D004279:DNA, Viral; D015774:Ganciclovir