title: Oral ganciclovir versus low-dose valganciclovir for prevention of cytomegalovirus disease in recipients of kidney and pancreas transplants.
abstract: BACKGROUND
  The optimal regimen for prophylaxis of cytomegalovirus (CMV) disease after kidney and/or pancreas transplantation remains unclear. We compared the effectiveness of three months of oral ganciclovir (3 g/day) versus low-dose valganciclovir (450 mg/day) for CMV prophylaxis.
  
  
  METHODS
  We performed a retrospective cohort study of patients at our center who received kidney and/or pancreas transplants between January 2000 and April 2003. We used a Cox proportional hazards model to examine the relationship between baseline covariates, including type of CMV prophylaxis, and time to development of CMV disease.
  
  
  RESULTS
  Of the 500 patients (295 ganciclovir, 205 valganciclovir), 22 patients (4.4%) developed CMV disease (mean time to CMV disease, 163+/-85 days). Sixteen of the ganciclovir patients (5.4%) and six of the valganciclovir patients (2.9%) developed CMV disease (P=0.18). By CMV serostatus, the incidence of CMV disease during the first posttransplant year was 8.5% among donor-seropositive, recipient-seronegative (D+/R-) patients, 8.6% among D+/R+ patients, 2.9% among D-/R+ patients, 1.0% among D-/R- patients, and 0.9% among patients for whom documentation of CMV serostatus was incomplete. In the unadjusted Cox proportional hazards analysis, race/ethnicity, type of transplant, type of antiviral prophylaxis, CMV serostatus, and use of mycophenolate mofetil were each associated with risk of developing CMV disease. In the adjusted, multivariable model, only CMV serostatus was associated with development of CMV disease.
  
  
  CONCLUSIONS
  Three months of low-dose valganciclovir (450 mg/day) was as effective as ganciclovir (3 g/day) for prophylaxis of CMV disease after kidney and/or pancreas transplantation.
authors.affiliation: Department of Medicine, Saint Barnabas Medical Center, Livingston, NJ 07039, USA.
authors.forename: Francis L
authors.initials: FL
authors.lastname: Weng
authors.forename: Anup M
authors.initials: AM
authors.lastname: Patel
authors.forename: Rimda
authors.initials: R
authors.lastname: Wanchoo
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Brahmbhatt
authors.forename: Kezia
authors.initials: K
authors.lastname: Ribeiro
authors.forename: Marc E
authors.initials: ME
authors.lastname: Uknis
authors.forename: Shamkant
authors.initials: S
authors.lastname: Mulgaonkar
authors.forename: A Scott
authors.initials: AS
authors.lastname: Mathis
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D015988:Cohort Effect; D003586:Cytomegalovirus Infections / Q000517:prevention & control*; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D012189:Retrospective Studies; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir