title: Universal valganciclovir prophylaxis significantly reduces episodes of first-year cytomegalovirus disease and biopsy-proven acute rejection in kidney transplant recipients.
abstract: BACKGROUND
  Cytomegalovirus (CMV) remains the most critical viral pathogen after kidney transplantation (KTx). The universal prophylaxis, but not pre-emptive therapy, could avoid the wide range of indirect effects induced by CMV infection. This study aims to examine the effect of universal prophylaxis with oral valganciclovir for the first year of CMV disease after KTx.
  
  
  METHODS
  The universal prophylaxis therapy was started in May 2008. Patients who received KTx between January 2006 and September 2010 were included in the study. Oral valganciclovir (Valcyte) was used for 3 months with dosage adjusted by eGFR. CMV disease was defined by typical CMV syndrome with positive viremia or tissue proven. The study end points are episode of CMV disease and first-year biopsy-proven acute rejection.
  
  
  RESULTS
  In total, 68 KTx patients who received universal prophylaxis for 3 months (study group) and another 50 KTx recipients without universal prophylaxis (control group) were enrolled. The incidence of CMV disease was 8.0% (4 of 50) in the control group. The universal prophylaxis significantly reduced the first-year episodes of CMV disease to 0% (0 of 68). There were 8 episodes of biopsy-proven acute rejection (8 of 50, 16%) within 1 year after KTx in the control group, but only 2 episodes of biopsy-proven acute rejection (2 of 68, 2.9%) in the treatment group (P < .05).
  
  
  CONCLUSIONS
  Universal prophylaxis with oral valganciclovir for 3 months significantly reduced episodes of first-year CMV disease and biopsy-proven acute rejection in kidney transplant recipients.
authors.affiliation: Division of Nephrology, Taichung Veterans General Hospital, Taiwan.
authors.forename: P T
authors.initials: PT
authors.lastname: Tu
authors.affiliation: Division of Nephrology, Taichung Veterans General Hospital, Taiwan; School of Medicine, Chung Shan Medical University, Taiwan.
authors.forename: K H
authors.initials: KH
authors.lastname: Shu
authors.affiliation: Division of Nephrology, Taichung Veterans General Hospital, Taiwan; School of Medicine, Chung Shan Medical University, Taiwan.
authors.forename: C H
authors.initials: CH
authors.lastname: Cheng
authors.affiliation: Division of Nephrology, Taichung Veterans General Hospital, Taiwan; Graduate Institute of Clinical Medical Science, School of Medicine, China Medical University, Taiwan.
authors.forename: C H
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Division of Nephrology, Taichung Veterans General Hospital, Taiwan; Graduate Institute of Clinical Medical Science, School of Medicine, China Medical University, Taiwan.
authors.forename: T M
authors.initials: TM
authors.lastname: Yu
authors.affiliation: Division of Nephrology, Taichung Veterans General Hospital, Taiwan; Graduate Institute of Clinical Medical Science, School of Medicine, China Medical University, Taiwan.
authors.forename: Y W
authors.initials: YW
authors.lastname: Chuang
authors.affiliation: Division of Nephrology, Taichung Veterans General Hospital, Taiwan; Graduate Institute of Clinical Medical Science, School of Medicine, China Medical University, Taiwan.
authors.forename: S T
authors.initials: ST
authors.lastname: Huang
authors.affiliation: Division of Nephrology, Taichung Veterans General Hospital, Taiwan; Department of Life Science, Tunghai University, Taiwan.
authors.forename: S F
authors.initials: SF
authors.lastname: Tsai
authors.affiliation: Department of Pharmacy, Taichung Veterans General Hospital, Taiwan.
authors.forename: C Y
authors.initials: CY
authors.lastname: Cheng
authors.affiliation: Division of Nephrology, Taichung Veterans General Hospital, Taiwan; School of Medicine, Chung Shan Medical University, Taiwan; Graduate Institute of Clinical Medical Science, School of Medicine, China Medical University, Taiwan; Institute of Biomedical Science, National Chung Hsing University, Taiwan; Department of Life Science, Tunghai University, Taiwan. Electronic address: wmj530@gmail.com.
authors.forename: M J
authors.initials: MJ
authors.lastname: Wu
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D003586:Cytomegalovirus Infections / Q000188:drug therapy*; D015774:Ganciclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006084:Graft Rejection; D006801:Humans; D016030:Kidney Transplantation; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir