Cytomegalovirus disease in high-risk transplant recipients despite ganciclovir or valganciclovir prophylaxis.
The clinical patterns and predictors of cytomegalovirus (CMV) disease in kidney and/or pancreas transplant patients on ganciclovir (1.0 g po t.i.d.) or valganciclovir (450 mg po q.d.) prophylaxis were studied. This is a retrospective analysis of 129 transplant recipients. Median follow up was 12 months (range, 6-18 months). The overall incidence of CMV disease at 1-year post-transplant was 14% (4% tissue-invasive, 10% noninvasive). Seventeen of 18 patients were diagnosed with CMV after completion of 3 months' prophylaxis (median 8 weeks, range, 2-28 weeks). Induction treatment with thymoglobulin, and Donor +/Recipient - CMV status were the strongest predictors for the development of CMV disease. Cytomegalovirus incidence was not different between patients treated with ganciclovir or valganciclovir (15 vs. 17%, respectively). Valganciclovir (450 mg q.d.) is as effective as oral ganciclovir in CMV prophylaxis. High-risk individuals might require higher doses or longer duration of valganciclovir treatment.
Akalin
Enver
E
Department of Nephrology Recanati/Miller Transplantation Institute, Mount Sinai School of Medicine, New York, NY, USA. akalin@msnyu-health.org
Sehgal
Vinita
V
Ames
Scott
S
Hossain
Sabera
S
Daly
Lisa
L
Barbara
Murphy
M
Bromberg
Jonathan S
JS
D000998:Antiviral Agents / Q000494:pharmacology*; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000494:pharmacology*; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D016030:Kidney Transplantation; D008297:Male; D016035:Pancreas Transplantation; D000077562:Valganciclovir
D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir