[Prophylactic and pre-emptive therapy for cytomegalovirus infection in kidney transplant patients using oral valganciclovir].
Prophylactic and pre-emptive therapy with oral valganciclovir for cytomegalovirus infection in renal transplant recipients.


BACKGROUND
Cytomegalovirus infection is a very important health problem in solid organ transplant recipients (SOT). Once-daily valganciclovir has been shown to be as clinically effective and well tolerated as oral ganciclovir tid in the prevention of CMV infection in high risk SOT recipients.


METHODS
The aim of the present study was to evaluate the incidence and severity of CMV disease in 150 renal transplant recipients that received either prophylactic [high risk group (HR), N = 66] or pre-emptive [low risk group (LR), N = 84] therapy with oral valganciclovir (900 mg/day vo) for three months according to their basal risk. Patients were monitored for signs and symptoms of CMV disease and CMV plasma viral load was assessed weekly.


RESULTS
A total of 31 patients (47%) of the HR and 26 patients (31%) of the LR presented a positive CMV PCR result. Twelve patients (14.3%) in the LR that had a high viral load (CMV PCR > 1,000 copies/mL) but remained asymptomatic received pre-emptive therapy. Four patients (4.7%) in the LR, after an average time of 35 days after transplant and two patients (4.5%) in the HR, after prophylactic treatment was completed, developed CMV disease. The disease was mild-moderate in most of the cases. Those patients that developed CMV disease responded to treatment with iv ganciclovir for 14 days followed by treatment with oral valganciclovir for up to three months.


CONCLUSIONS
Prophylactic treatment with oral valganciclovir for CMV prevention is only required in high risk solid organ transplant recipients.
Guirado
L
L
Servicio de Nefrología, Fundació Puigvert, Barcelona. 236991lgp@comb.es
Rabella
N
N
Díaz
J M
JM
Facundo
C
C
Maderuelo
A
A
Margall
N
N
Silva
I
I
García-Maset
R
R
Calabia
J
J
Giménez
I
I
Garra
N
N
Solà
R
R
Ballarín
J A
JA
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage*; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000517:prevention & control*; D015774:Ganciclovir / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation; D012307:Risk Factors; D000077562:Valganciclovir
D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir