Ganciclovir and acyclovir reduce the risk of post-transplant lymphoproliferative disorder in renal transplant recipients.
Given its association with Epstein-Barr virus (EBV), there is considerable interest in assessing the impact of prophylactic anti-viral therapy on post-transplant lymphoproliferative disorder (PTLD). A recently completed multi center case-control study assessed the impact of immunosuppressive therapy on PTLD risk among renal transplant patients and collected information on the use of anti-viral therapy. Biopsy-confirmed PTLD cases (n = 100) were matched to 375 controls by center, date of transplant, and age. Data were collected on immunosuppression and rejection therapies, demographics, pre-transplant viral status, number of rejections, and anti-viral use. With adjustment for known risk factors, prophylactic anti-viral use was associated with up to 83% reduction in the risk of PTLD, depending on the anti-viral agent. These results were stronger for the first year post-transplant. For every 30 days of ganciclovir treatment, risk of PTLD during the first year was lower by 38% (Odds Ratio [OR]= 0.62; 95% confidence interval [CI]= 0.38-1.0); acyclovir effects were less striking (OR = 0.83; 95% CI = 0.59-1.16). Anti-viral therapy appears to play a role in reducing the risk of PTLD in renal transplant patients. Ganciclovir may be more potent than acyclovir.
Funch
D P
DP
Ingenix Epidemiology, Auburndale, Massachusetts, USA. dfunch@epidemiology.com
Walker
A M
AM
Schneider
G
G
Ziyadeh
N J
NJ
Pescovitz
M D
MD
D000212:Acyclovir / Q000008:administration & dosage*; D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage*; D016022:Case-Control Studies; D015774:Ganciclovir / Q000008:administration & dosage*; D006801:Humans; D016030:Kidney Transplantation; D008232:Lymphoproliferative Disorders / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D012307:Risk Factors
D000998:Antiviral Agents; D015774:Ganciclovir; D000212:Acyclovir