title: Treatment of cytomegalovirus infection or disease in solid organ transplant recipients with valganciclovir.
abstract: Valganciclovir (VGC) has proved efficacious and safe for the prophylaxis against cytomegalovirus (CMV) in high-risk transplant recipients and for the treatment of CMV retinitis in AIDS patients. We used VGC for the treatment of CMV infection (viremia without symptoms) or disease (CMV syndrome or tissue-invasive disease) in kidney, heart, and lung transplant recipients. Fourteen transplant recipients were treated: five for asymptomatic CMV infection and nine for CMV disease. VGC was administered in doses adjusted to renal function for 4 to 12 weeks (induction and maintenance therapy). Clinically, all nine patients with CMV disease responded to treatment. Microbiologically, treatment with VGC turned blood culture negative for CMV within 2 weeks in all patients and was associated with a > or =2 log decrease in blood CMV DNA within 3 weeks in 8 of 8 tested patients. With a follow-up of 6 months (n = 12 patients), asymptomatic recurrent CMV viremia was noted in five cases, and CMV syndrome noted in one case (all cases in the first 2 months after the end of treatment). VGC was clinically well tolerated in all patients; however, laboratory abnormalities occurred in three cases (mild increase in transaminases, thrombocytopenia, and pancytopenia). This preliminary experience strongly suggests that therapy with VGC is effective against CMV in organ transplant recipients; however, the exact duration of therapy remains to be determined: a longer course may be necessary to prevent early recurrence.
authors.affiliation: Centre de Transplantation, Service de Pneumologie, Service de cardiologie, Institut de Microbiologie et Service des Maladies Infectieuses, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. j.fellay@hospvd.ch
authors.forename: J
authors.initials: J
authors.lastname: Fellay
authors.forename: J-P
authors.initials: JP
authors.lastname: Venetz
authors.forename: J-D
authors.initials: JD
authors.lastname: Aubert
authors.forename: C
authors.initials: C
authors.lastname: Seydoux
authors.forename: M
authors.initials: M
authors.lastname: Pascual
authors.forename: P R A
authors.initials: PR
authors.lastname: Meylan
mesh_terms: D000998:Antiviral Agents / Q000097:blood / Q000627:therapeutic use*; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000453:epidemiology*; D015774:Ganciclovir / Q000031:analogs & derivatives* / Q000097:blood / Q000627:therapeutic use; D016027:Heart Transplantation / Q000009:adverse effects / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology; D016040:Lung Transplantation / Q000009:adverse effects / Q000276:immunology; D016377:Organ Transplantation / Q000009:adverse effects*; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D000077562:Valganciclovir; D015774:Ganciclovir