title: Acyclovir versus valganciclovir for preventing cytomegalovirus infection in intermediate-risk liver transplant recipients.
abstract: BACKGROUND
  Cytomegalovirus (CMV) is an opportunistic infection that causes profound morbidity and mortality after orthotopic liver transplant (OLT). The CMV immunoglobulin G serostatuses of donors and recipients are the main factors influencing risk for development of CMV infection after transplant.
  
  
  OBJECTIVE
  To compare acyclovir and valganciclovir for preventing CMV infection after OLT.
  
  
  METHODS
  Retrospective assessment of adult OLT recipients at intermediate risk for CMV infection at New York Presbyterian Hospital.
  
  
  METHODS
  All patients received ganciclovir 5 mg/kg intravenously every 12 hours or valganciclovir 900 mg orally every 12 hours for 7 days after transplant. On postoperative day 8, patients received antiviral prophylaxis according to risk stratification: acyclovir 800 mg orally 3 times daily in donor seronegative/recipient seropositive (D-/R+) patients or valganciclovir 900 mg orally once daily in donor seropositive/recipient seropositive (D+/R+) patients.
  
  
  METHODS
  Composite incidence of CMV infection, syndrome, or tissue-invasive disease.
  
  
  RESULTS
  Of 275 OLT recipients, 89 were at intermediate risk for CMV infection (29 D-/R+, 60 D+/R+). CMV infection, syndrome, or tissue-invasive disease occurred in 1 patient (3%) in the D-/R+ group and 5 patients (8%) in the D+/R+ group (P=.66). One patient (3%) in the D-/R+ group had a CMV infection develop. Five D+/R+ recipients (8%) had CMV infection; 3 of them had CMV syndrome (5%), 1 had CMV hepatitis (1.6%), and the other had CMV esophagitis (1.6%); all events occurred after prophylaxis was discontinued. The rates of CMV infection were similar in D-/R+ patients treated with acyclovir and D+/R+ patients receiving valganciclovir. This risk-stratified approach to viral prophylaxis after OLT resulted in an acceptable rate of CMV infection in D-/R+ recipients and may avoid the costs and adverse effects associated with valganciclovir therapy.
authors.affiliation: Hackensack University Medical Center, Hackensack, New Jersey.
authors.forename: Jaclyn T
authors.initials: JT
authors.lastname: McKeen
authors.affiliation: New York-Presbyterian Hospital, Columbia University Medical Center, New York.
authors.forename: Demetra S
authors.initials: DS
authors.lastname: Tsapepas
authors.affiliation: New York-Presbyterian Hospital, Columbia University Medical Center, New York.
authors.forename: Hanlin
authors.initials: H
authors.lastname: Li
authors.affiliation: New York-Presbyterian Hospital, Columbia University Medical Center, New York.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Anamisis
authors.affiliation: Hartford Hospital, Hartford, Connecticut.
authors.forename: Spencer T
authors.initials: ST
authors.lastname: Martin
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use*; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D066027:Transplant Recipients; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir; D000212:Acyclovir