title: Low-dose valaciclovir prophylaxis against cytomegalovirus disease in renal transplant recipients.
abstract: High-dose valaciclovir at up to 8 g/day has been shown to be effective in prophylaxis against cytomegalovirus (CMV) disease in renal transplant recipients. We report our experience with low-dose valaciclovir prophylaxis of up to 3 g/day, adjusted to creatinine clearance. A group of patients at high risk of developing CMV disease who received prophylaxis were selected as the study group. This included all CMV-positive patients who received antilymphocyte therapy (R+, n=20) and all CMV-negative recipients of CMV-positive organs (D+R-, n=15). D+R- patients receiving antilymphocyte therapy were excluded, as most of the patients in the control group had received ganciclovir prophylaxis. A historical control group was used, which consisted of patients who did not receive prophylaxis. Low-dose valaciclovir prophylaxis resulted in a statistically significant decrease (8.5 vs 37%, P=0.004) in CMV disease in the study group at 6 months. On subgroup analysis the decrease was statistically significant only in the R+ group (5 vs 45%, P=0.003), not in the D+R- group (13.3 vs 26.6%, P=0.651). Low-dose valaciclovir prophylaxis seems to be adequate for R+ patients receiving antilymphocyte therapy. The role of low-dose valaciclovir prophylaxis needs to be assessed further in a prospective trial.
authors.affiliation: Nuffield Department of Surgery, Oxford University, John Radcliffe Hospital, Headington, Oxfordshire OX3 9DU, UK. srikanth.reddy@nds.ox.ac.uk
authors.forename: Srikanth P
authors.initials: SP
authors.lastname: Reddy
authors.forename: Ashok
authors.initials: A
authors.lastname: Handa
authors.forename: Liamchin
authors.initials: L
authors.lastname: Tan
authors.forename: Andrea
authors.initials: A
authors.lastname: Devaney
authors.forename: David
authors.initials: D
authors.lastname: Hughes
authors.forename: Phillip
authors.initials: P
authors.lastname: Mason
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Friend
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Darby
mesh_terms: D000212:Acyclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D003586:Cytomegalovirus Infections / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000502:physiology*; D019520:Living Donors; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control / Q000821:virology*; D011355:Prodrugs / Q000627:therapeutic use; D012086:Reoperation; D012189:Retrospective Studies; D014019:Tissue Donors; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives* / Q000627:therapeutic use*
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D011355:Prodrugs; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir