LONG-TERM ORAL GANCICLOVIR PROPHYLAXIS FOR PREVENTION OF CYTOMEGALOVIRUS INFECTION AND DISEASE IN CYTOMEGALOVIRUS HIGH-RISK RENAL TRANSPLANT RECIPIENTS

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Abstract
Although specific therapy is available with ganciclovir, cytomegalovirus (CMV) disease remains a major problem after renal transplantation especially in CMV seronegative recipients of organs of seropositive donors (D+R-). In an open-labeled prospective controlled trial we evaluated the effect of long-term oral ganciclovir prophylaxis (3 g/day for 3 months posttransplantation) in a cohort of 31 CMV-high risk (D+R-) renal transplant recipients (GC) compared with a cohort of 28 high-risk patients with targeted CMV prophylaxis (CO) receiving i.v. ganciclovir during anti-rejection therapy. Primary end-points were CMV infection, diagnosed by pp65 antigenemia assay or serologic method, and CMV disease. Additionally severity of CMV disease quantified by a scoring system was evaluated. CMV prophylaxis significantly reduced the incidence of CMV infection (CO: 75%, GC: 45%;P <.05) and CMV disease (CO: 60%, GC: 29%;P <.05) without relevant side effects and without any clinical suspicion of ganciclovir resistance. Severity of CMV disease as quantified by a scoring system was reduced from 8.3±6.7 points in controls to 3.3±2.6 points in ganciclovir-treated patients (P <.05). Mortality did not differ significantly between the two groups (CO: n=3, GC: n=1; NS). However, there was one lethal CMV disease and a second death possibly attributable to CMV disease in the control group, whereas in ganciclovir-treated patients there was no CMV-associated fatal outcome. Long-term oral ganciclovir prophylaxis is effective and safe in CMV high-risk renal transplant recipients.