title: Ganciclovir prophylaxis delays but does not prevent cytomegalovirus infection in renal transplant recipients.
abstract: Cytomegalovirus (CMV) infection is associated with reduced graft and patient survival among renal transplant recipients. The purpose of this study was to examine the effect of routine prophylaxis with 12 weeks of oral ganciclovir on the incidence of CMV infection in a center that predominantly uses antibody induction together with tacrolimus/mycophenolate mofetil-based maintenance immunosuppressive therapy. The control group consisted of a historical patient cohort transplanted immediately prior to the use of oral ganciclovir prophylaxis. The use of tacrolimus (88% vs 77%, P=.02) and cytolytic therapy (81% vs 46%, P <.0001) was likewise greater among patients who received ganciclovir prophylaxis. CMV infection occurred in 20 (9%) patients in the ganciclovir era and 4 (3%) patients in the preganciclovir era (P=.003). The mean time to CMV infection was longer in patients who received ganciclovir prophylaxis than in patients in the preganciclovir era (23.4 +/- 10.9 weeks vs 9.8 +/- 5.6 weeks, P=.03). We conclude that 12 weeks of ganciclovir prophylaxis delays but does not prevent CMV infection from occurring in renal transplant recipients. These results suggest that with the use of 12 weeks of ganciclovir prophylaxis, vigilance for CMV infection is needed well beyond 24 weeks posttransplant.
authors.affiliation: Renal-Electrolyte and Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia, 19104, USA.
authors.forename: A
authors.initials: A
authors.lastname: Israni
authors.forename: K
authors.initials: K
authors.lastname: Krok
authors.forename: D
authors.initials: D
authors.lastname: Cohen
authors.forename: E
authors.initials: E
authors.lastname: Blumberg
authors.forename: R D
authors.initials: RD
authors.lastname: Bloom
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000998:Antiviral Agents / Q000627:therapeutic use*; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000517:prevention & control*; D003710:Demography; D005260:Female; D005500:Follow-Up Studies; D015774:Ganciclovir / Q000627:therapeutic use*; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014481:United States
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D015774:Ganciclovir