A Randomized Prospective Controlled Trial of Oral Acyclovir Versus Oral Ganciclovir for Cytomegalovirus Prophylaxis in High-Risk Kidney Transplant Recipients1

Flechner, Stuart M.; Avery, Robin K.; Fisher, R; Mastroianni, Barbara; Papajcik, Doreen; O’Malley, Kiaran; Goormastic, Marlene; Goldfarb, David A.; Modlin, Charles S.; Novick, Andrew C.

doi:10.1097/00007890-199812270-00019

Cited by 129 publications

(55 citation statements)

References 33 publications

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“…[16][17][18] Valganciclovir with its favorable pharmacokinetic profile was developed to overcome the limitations of ganciclovir. A single once-daily 900-mg oral dose of valganciclovir provides comparable plasma exposures to those achieved with 5 mg/kg intravenous ganciclovir.…”

Section: Successful Cost-effective Prevention Of Cytomegalovirusmentioning

confidence: 99%

Untitled

Gheith

Halim

Al-Otaibi³

et al. 2017

Exp Clin Transplant

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Objectives: Low-dose valganciclovir prophylaxis is still under investigation in renal transplant procedures. Our aim was to assess the cost effectiveness of 450 mg versus 900 mg valganciclovir prophylaxis in kidney transplant recipients. Materials and Methods: In this prospective trial, 201 kidney transplant patients were randomized (1:1) to receive 450 mg/d (group 1, n = 100) or 900 mg/d (group 2, n = 101) valganciclovir prophylaxis for the first 6 months after transplant. Patients were studied for incidence of cytomegalovirus disease, leukopenia episodes, rejection episodes, and graft outcomes along with associated costs over 1 year. Costs (in US dollars) of treatment of rejection were also analyzed. Results: Demographic features of the studied groups were comparable. We found that the cost of cytomegalovirus care in group 1 patients was significantly lower (by 50% at 6 months; P < .001), with less leukopenia episodes (P = .04), lower doses of granulocyte colony-stimulating factor (by 30% at 6 months; P = .03), higher doses of mycophenolate mofetil (P = .04), and less rejection episodes (P = .01) compared with group 2. In group 2, there were more episodes of cytomegalovirus infection (P = .052) and BK virus nephropathy (P = .04). Graft and patient outcomes were satisfactory in both groups. Conclusions: Low-dose valganciclovir for cytomegalovirus prophylaxis after renal transplant is safer, effective and without breakthrough infection, and less costly than using the usual dose.

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Section: Successful Cost-effective Prevention Of Cytomegalovirusmentioning

confidence: 99%

Untitled

Gheith

Halim

Al-Otaibi³

et al. 2017

Exp Clin Transplant

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“…Only 7.5%of patients contracted symptomatic CMV infection during the first year by treating patients with prophylactic acyclovir following renal transplantation, compared to 28% in two placebo groups [11]. Acyclovir has largely been supplemented by ganciclovir [12] and by valganciclovir in high-risk kidney transplant recipients [13]. Recent reports, however, have begun to illustrate the emergence of cytomegalovirus resistance in patients who received valganciclovir prophylaxis [14].…”

Section: Discussionmentioning

confidence: 99%

A Case of Native Cytomegalovirus Pancreatitis Following Deceased-Donor Renal Transplantation

Schwartz¹,

Woods²,

Shihab³

2009

TOTRANSJ

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Cytomegalovirus (CMV) is a known cause of pancreatitis in immunocompromised patients, usually in association with the human immunodeficiency virus [1]. A handful of cases have been reported of CMV pancreatitis occurring in a transplanted pancreas secondary to immunosuppression associated with organ transplantation. Herein, we report a rare case of CMV pancreatitis following deceased-donor renal transplantation in which a patient's native pancreas was infected by CMV transmitted by donor renal tissue. After seroconversion from a CMV-positive donor, a 41 year old female with a history of autosomal dominant polycystic kidney disease presented with pancreatitis in her native pancreas following deceased donor renal transplantation, thus illustrating how a patient's native pancreas can be infected by CMV from donor renal tissue.

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“…13 The effectiveness of oral acyclovir has been studied in many trials; however, it has been shown that the effectiveness is not adequate for donor seropositive/recipient seronegative patients. 14,15 Valacyclovir is a newly introduced agent to reduce CMV infections and rejections. Valacyclovir prophylaxis has been shown to reduce the incidence of CMV disease from 22% to 2%.…”

Section: Umit Kervan Et Al/experimental and Clinical Transplantation mentioning

confidence: 99%

Untitled

Kervan

Küçüker²,

Kocabeyoğlu³

et al. 2016

Exp Clin Transplant

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Objectives: Cytomegalovirus infection is a major cause of morbidity and mortality in solid-organ transplant. Low doses of valacyclovir have been administered as cytomegalovirus prophylaxis in our institution for years. To the best of our knowledge, there is no published study of a low-dose regimen for cytomegalovirus prophylaxis in heart transplant patients. Therefore, our aim was to determine the results of low doses of valacyclovir in heart transplant. Materials and Methods: Between September 2006and December 2014, sixty-eight patients underwent orthotopic heart transplants. All of the patients received triple immunosuppressive therapy after surgery. During the next 6 months, sulfamethoxazole/trimethoprim was administered for Pneumocystis jiroveci pneumonia, and toxoplasmosis. Additionally all patients received valacyclovir hydrochloride (1000 mg/d, oral) for cytomegalovirus prophylaxis and nystatin oral rinse for prophylaxis of fungal infections. Results: There was only 1 cytomegalovirus infection at follow-up. The patient had cytomegalovirus pneumonia at 17-month follow-up. In response to treatment with 1-week intravenous ganciclovir, the patient was discharged with a further 6-month oral valacyclovir therapy (1000 mg/d). Conclusions: In this study, we hypothesized that daily use of low-dose valacyclovir (1000 mg/d) is not only sufficient for cytomegalovirus prophylaxis but also beneficial in terms of cost.

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A Randomized Prospective Controlled Trial of Oral Acyclovir Versus Oral Ganciclovir for Cytomegalovirus Prophylaxis in High-Risk Kidney Transplant Recipients1

Cited by 129 publications

References 33 publications

Untitled

Untitled

A Case of Native Cytomegalovirus Pancreatitis Following Deceased-Donor Renal Transplantation

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