title: Initial experience with oral valganciclovir for pre-emptive cytomegalovirus therapy after lung transplantation.
abstract: BACKGROUND
  The most common opportunistic viral pathogen after lung transplantation is cytomegalovirus (CMV). Oral valganciclovir, a prodrug of ganciclovir, has been introduced as a potential drug for prophylaxis and treatment of CMV infection and disease in lung transplantation. The goal of this study was to describe our initial experience with oral valganciclovir for pre-emptive treatment of CMV infections after lung transplantation.
  
  
  METHODS
  We summarize our experience with 19 patients who underwent lung transplantation and received pre-emptive oral valganciclovir therapy in the situation of positive CMV polymerase chain reaction (PCR) in either plasma or bronchoalveolar lavage. None of the patients presented with manifest CMV disease. Treatment dosage of valganciclovir was 450 mg to 1800 mg daily, depending on renal function and white blood count. Treatment was continued until the CMV PCR became negative, in any case for a period of at least 14 days.
  
  
  RESULTS
  Three patients received two courses of pre-emptive oral valganciclovir; 16 patients were treated once. Eleven patients (57.9%) were treated because of a positive plasma CMV PCR; in eight patients (42.1%) the PCR was positive only in bronchoalveolar lavage. Therapy was initiated 896 +/- 1186 days (range, 108-3911) after transplantation with a mean CMV PCR of 45,536 +/- 149,294 copies (range, 426-706,000). In all cases the PCR fell below detectability (<400 copies) after a period of 22 +/- 10 days of treatment (range, 7-50 days). Mild to moderate leucopenia was observed in seven patients (36.8%) during treatment. None of the patients developed new onset of other potentially drug-related disorders such as neutropenia, anemia, deterioration of renal function or gastrointestinal disorder.
  
  
  CONCLUSIONS
  Pre-emptive therapy with oral valganciclovir for CMV infections detected by PCR in either plasma or bronchoalveolar lavage after lung transplantation seems to be efficacious and safe. However, regular blood counts should be performed to detect developing leucopenia.
authors.affiliation: Department of Cardiothoracic Surgery, Vienna General Hospital, Vienna Medical University, Vienna, Austria.
authors.forename: Clemens
authors.initials: C
authors.lastname: Aigner
authors.forename: Peter
authors.initials: P
authors.lastname: Jaksch
authors.forename: Guenther
authors.initials: G
authors.lastname: Winkler
authors.forename: Kriztina
authors.initials: K
authors.lastname: Czebe
authors.forename: Shahrokh
authors.initials: S
authors.lastname: Taghavi
authors.forename: Gabriel
authors.initials: G
authors.lastname: Marta
authors.forename: Walter
authors.initials: W
authors.lastname: Klepetko
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage; D003587:Cytomegalovirus / Q000187:drug effects* / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000209:etiology* / Q000517:prevention & control*; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000209:etiology* / Q000517:prevention & control*; D010865:Pilot Projects; D011182:Postoperative Care / Q000379:methods; D016896:Treatment Outcome; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir