title: Following universal prophylaxis with intravenous ganciclovir and cytomegalovirus immune globulin, valganciclovir is safe and effective for prevention of CMV infection following lung transplantation.
abstract: We prospectively determined the safety and efficacy of valganciclovir for prevention of cytomegalovirus (CMV) in at-risk (donor positive/recipient negative [D+/R-] or R+) lung transplant recipients. We also determined the length of prophylaxis required to significantly decrease both CMV infection and disease. Consecutive lung transplant recipients surviving >30 days (n = 90) received combination prophylaxis with intravenous (i.v.) ganciclovir (GCV) 5 mg/kg/day and cytomegalovirus immune globulin (CMV-IVIG) followed by valganciclovir (450 mg twice-daily) to complete 180, 270 or 365 days of prophylaxis. This group was compared to a historical group (n = 140) who received high-dose oral acyclovir following i.v. GCV and CMV-IVIG. CMV disease was significantly lower in patients receiving valganciclovir compared to acyclovir (2.2% vs. 20%; p < 0.0001). Freedom from CMV infection and disease was significantly greater (p < 0.02) in patients receiving 180, 270 or 365 days of prophylaxis (90%, 95% and 90%, respectively) compared to those receiving 100-179 days (64%) or < 100 days (59%). No patient receiving valganciclovir died during the study. Following prophylaxis with i.v. GCV and CMV-IVIG, valganciclovir is safe and effective for prevention of CMV infection and disease in at-risk lung transplant recipients. The required length of prophylaxis was at least 180 days.
authors.affiliation: Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, Denver, CO, USA. Marty.Zamora@uchsc.edu
authors.forename: Martin R
authors.initials: MR
authors.lastname: Zamora
authors.forename: Mark R
authors.initials: MR
authors.lastname: Nicolls
authors.forename: Tony N
authors.initials: TN
authors.lastname: Hodges
authors.forename: Jane
authors.initials: J
authors.lastname: Marquesen
authors.forename: Todd
authors.initials: T
authors.lastname: Astor
authors.forename: Todd
authors.initials: T
authors.lastname: Grazia
authors.forename: David
authors.initials: D
authors.lastname: Weill
mesh_terms: D000998:Antiviral Agents / Q000276:immunology / Q000494:pharmacology*; D003587:Cytomegalovirus / Q000187:drug effects / Q000235:genetics; D003586:Cytomegalovirus Infections / Q000276:immunology / Q000517:prevention & control*; D024882:Drug Resistance, Viral / Q000235:genetics / Q000502:physiology; D015774:Ganciclovir / Q000031:analogs & derivatives* / Q000494:pharmacology*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000276:immunology / Q000494:pharmacology*; D008168:Lung / Q000276:immunology / Q000821:virology; D016040:Lung Transplantation; D013534:Survival; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous; D000077562:Valganciclovir; D015774:Ganciclovir