title: Clinical outcome with low-dose valacyclovir in high-risk renal transplant recipients: a 10-year experience.
abstract: BACKGROUND
  Cytomegalovirus (CMV) remains an important pathogen in transplant patients, and valacyclovir (VACV) prophylaxis 8 g/day has been used in high-risk CMV-seromismatched [D+/R-] renal transplant patients to decrease CMV disease. Neurotoxic adverse effects have limited its use, and the aim of the present study was to retrospectively evaluate low-dose VACV prophylaxis, 3 g/day for 90 days after transplantation, in 102 D+/R- renal transplant patients.
  
  
  METHODS
  We compared patient and graft survival rates up to 5 years after transplantation with the data from the Collaborative Transplant Study Group (CTS) database. The incidence of CMV disease, rejection and neurotoxic adverse effects was analyzed up to 1 year after transplantation.
  
  
  RESULTS
  The patient and graft survival rates up to 5 years were comparable with those derived from the CTS. CMV disease was diagnosed in 25% of the patients and 2% developed tissue-invasive CMV disease. The rejection frequency was 22% and neurotoxic adverse effects were seen in 2% of the patients.
  
  
  CONCLUSIONS
  Low-dose VACV prophylaxis (3 g/day) for 90 days post-transplantation results in high patient and graft survival rates and reduces the incidence of CMV disease. Neurotoxic adverse effects are minimal. We believe that low-dose VACV prophylaxis should be considered to form one of the arms in future prospective comparison studies for the prevention of CMV disease in the high-risk D+/R- population of renal transplant patients.
authors.affiliation: Department of Medical Sciences, Uppsala University, Uppsala, Sweden. fredrik.sund@akademiska.se
authors.forename: Fredrik
authors.initials: F
authors.lastname: Sund
authors.forename: Gunnar
authors.initials: G
authors.lastname: Tufveson
authors.forename: Bernd
authors.initials: B
authors.lastname: Döhler
authors.forename: Gerhard
authors.initials: G
authors.lastname: Opelz
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Eriksson
mesh_terms: D000212:Acyclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D019072:Antibiotic Prophylaxis; D000998:Antiviral Agents / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000235:genetics / Q000472:pathogenicity; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir