title: Valganciclovir as preemptive therapy for cytomegalovirus in cytomegalovirus-seronegative liver transplant recipients of cytomegalovirus-seropositive donor allografts.
abstract: The efficacy of valganciclovir as preemptive therapy for the prevention of cytomegalovirus (CMV) disease and its impact on indirect sequelae of CMV were assessed in recipient-negative/donor-positive (R-/D+) liver transplant recipients. Of 187 consecutive liver transplant recipients at our institution since July 2001, 36 (19.2%) belonged to the R-/D+ group. Surveillance tests for CMV were performed on all patients at weeks 2, 4, 6, 8, 10,12, and 16. In all, 27 patients with asymptomatic viremia received preemptive therapy with valganciclovir. At a total follow-up of 62.8 patient years (median: 19 months, range: 3 months to 5.6 years), no episodes of CMV disease were documented in these patients. The incidence of rejection, retransplantation, and bacterial or fungal infections and the probability of survival did not differ for R-/D+ patients and all non-R-/D+ patients treated preemptively with valganciclovir (P > 0.20 for all variables). Thus, preemptive therapy with valganciclovir in R-/D+ patients was not associated with CMV disease during the period of surveillance monitoring or at anytime thereafter (late-onset CMV disease). The indirect outcomes with the use of valganciclovir in R-/D+ patients were comparable to the outcomes of other subgroups of liver transplant recipients receiving preemptive therapy.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA. nis5@pitt.edu
authors.forename: Nina
authors.initials: N
authors.lastname: Singh
authors.forename: Cheryl
authors.initials: C
authors.lastname: Wannstedt
authors.forename: Lois
authors.initials: L
authors.lastname: Keyes
authors.forename: Debra
authors.initials: D
authors.lastname: Mayher
authors.forename: Lisa
authors.initials: L
authors.lastname: Tickerhoof
authors.forename: Mohamed
authors.initials: M
authors.lastname: Akoad
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Wagener
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Cacciarelli
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000235:genetics / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000517:prevention & control* / Q000821:virology; D004279:DNA, Viral / Q000097:blood; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D008099:Liver / Q000601:surgery / Q000821:virology*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010750:Phosphoproteins / Q000097:blood*; D012008:Recurrence; D013997:Time Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D000077562:Valganciclovir; D019562:Viral Load; D014763:Viral Matrix Proteins / Q000097:blood*; D014766:Viremia / Q000517:prevention & control
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D010750:Phosphoproteins; D014763:Viral Matrix Proteins; C065418:cytomegalovirus matrix protein 65kDa; D000077562:Valganciclovir; D015774:Ganciclovir