+ Site Statistics
References:
54,258,434
Abstracts:
29,560,870
PMIDs:
28,072,757
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Late cytomegalovirus infection after oral ganciclovir prophylaxis in renal transplant recipients



Late cytomegalovirus infection after oral ganciclovir prophylaxis in renal transplant recipients



Transplant Infectious Disease 6(1): 3-9



The purpose of this study was to retrospectively review our experience with a consecutive group of 41 renal transplant recipients (R) who received a kidney from a cytomegalovirus (CMV) seropositive donor (D(+)) and had 3 months of prophylaxis with oral ganciclovir. Patients were prospectively monitored clinically and with determinations of CMV antigenemia for at least 6 months. Patients were followed for a mean period of 247+/-16 days. CMV antigenemia developed in 51% of patients (53% D(+)R(-), 47% D(+)R(+)) after the transplant, but in no case was antigenemia seen during the period of oral ganciclovir therapy. Antigenemia developed at a median of 167 days post transplant (range 99-522 days) and peak antigen counts ranged from <1-3940, and tended to be higher in D(+)R(-) recipients. Infection was symptomatic in 67% of the antigenemic patients and symptoms tended to be more marked in the D(+)/R(-) than in the D(+)/R(+) group. All symptomatic patients were treated with intravenous ganciclovir (21 days) followed by 9 weeks of oral ganciclovir and responded with resolution of symptoms and antigenemia. No evidence of tissue-invasive disease was seen. Recurrence of antigenemia was observed exclusively in the D(+)R(-) group, occurred with less severe manifestations of CMV infection, and invariably responded to retreatment with ganciclovir. Our results suggest that oral ganciclovir prophylaxis is effective in preventing CMV infection during the 3-month period of prophylaxis, that a 3-month period of prophylaxis appears to be sufficient for D(+)R(+) recipients, but a longer period of oral ganciclovir prophylaxis may be needed in D(+)R(-) recipients. Clinicians caring for renal transplant recipients should be vigilant to the possibility of late CMV infection, especially in D(+)R(-) recipients.

(PDF emailed within 0-6 h: $19.90)

Accession: 049453868

Download citation: RISBibTeXText

PMID: 15225220

DOI: 10.1111/j.1399-3062.2004.00043.x


Related references

Long-term oral ganciclovir prophylaxis for prevention of cytomegalovirus infection and disease in cytomegalovirus high-risk renal transplant recipients. Transplantation 70(8): 1174-1180, 2000

A simplified strategy for clinical management of late cytomegalovirus infection after oral ganciclovir prophylaxis in renal recipients. Journal of Antimicrobial ChemoTherapy 55(3): 391-394, 2005

Randomized controlled trial of oral ganciclovir versus oral acyclovir after induction with intravenous ganciclovir for long-term prophylaxis of cytomegalovirus disease in cytomegalovirus-seropositive liver transplant recipients. Transplantation 75(2): 229-233, 2003

Ganciclovir prophylaxis delays but does not prevent cytomegalovirus infection in renal transplant recipients. Transplantation Proceedings 36(10): 3019-3024, 2005

A comparative randomised study of valacyclovir vs. oral ganciclovir for cytomegalovirus prophylaxis in renal transplant recipients. Clinical Microbiology and Infection 11(9): 736-743, 2005

Detection of ganciclovir resistance after valacyclovir-prophylaxis in renal transplant recipients with active cytomegalovirus infection. Journal of Medical Virology 73(4): 566-573, 2004

Randomized controlled trial of sequential intravenous and oral ganciclovir versus prolonged intravenous ganciclovir for long-term prophylaxis of cytomegalovirus disease in high-risk cytomegalovirus-seronegative liver transplant recipients with cytomegalovirus-seropositive donors. Transplantation 77(2): 305-308, 2004

Randomized comparison of oral ganciclovir versus oral acyclovir for long-term cytomegalovirus prophylaxis in cytomegalovirus-seropositive liver transplant recipients. International Journal of Antimicrobial Agents 17(Suppl. 1): S57-S58, 2001

Randomized controlled trial of oral ganciclovir versus intravenous ganciclovir for long-term prophylaxis of cytomegalovirus disease in CMV-seronegative liver transplant recipients willi CMV-seropositive donors. International Journal of Infectious Diseases 6(Suppl. 2): 2S26-2S27, 2002

Prevention of primary cytomegalovirus disease in organ transplant recipients with oral ganciclovir or oral acyclovir prophylaxis. Transplant Infectious Disease 2(3): 112-117, 2001

Cytomegalovirus antigenemia directed pre-emptive prophylaxis with oral versus I.V. ganciclovir for the prevention of cytomegalovirus disease in liver transplant recipients: a randomized, controlled trial. Transplantation 70(5): 717-722, 2000

Effective oral ganciclovir prophylaxis against cytomegalovirus disease in heart transplant recipients. Transplantation Proceedings 30(8): 4110-4112, 1998

Increased incidence of cytomegalovirus infection in high-risk liver transplant recipients receiving valganciclovir prophylaxis versus ganciclovir prophylaxis. Liver Transplantation 15(8): 963-967, 2009

Outcome of low-dose ganciclovir for cytomegalovirus disease prophylaxis in renal-transplant recipients. Transplantation 78(11): 1689-1692, 2004

Ganciclovir in cytomegalovirus prophylaxis in high-risk pediatric renal transplant recipients. Transplantation Proceedings 25(4): 2577, 1993