Does Valganciclovir Hydrochloride (Valcyte) Provide Effective Prophylaxis Against Cytomegalovirus Infection in Liver Transplant Recipients?

Jain, Ashokkumar; Orloff, Mark S.; Kashyap, Randeep; Lansing, K.; Betts, Robert F.; Mohanka, Ravi; Menegus, Marilyn A.; Ryan, Charlotte; Bozorgzadeh, Adel

doi:10.1016/j.transproceed.2005.07.032

Cited by 52 publications

(66 citation statements)

References 20 publications

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“…CMV disease occurs rarely during prophylaxis with oral valganciclovir. Data adapted from references [4,5,77].…”

Section: Indirect CMV Effectsmentioning

confidence: 99%

“…In many highrisk CMV D+/R individuals, the use of antiviral prophylaxis has only delayed the onset of CMV disease to 36 mo after liver transplantation [35,13] . In a retrospective study, CMV disease occurred in 14 of 54 (26%) CMV D+/R liver transplant recipients who completed at least 3 mo of valganciclovir prophylaxis (Figure 1) [77] . In another ret rospective study on 203 liver transplant recipients who received valganciclovir 900 mg daily for 3 to 6 mo, the overall incidence of CMV disease was 14%.…”

Section: Delayed-and Late-onset CMV Diseasementioning

confidence: 99%

“…In another ret rospective study on 203 liver transplant recipients who received valganciclovir 900 mg daily for 3 to 6 mo, the overall incidence of CMV disease was 14%. The inci dence varied among the different CMV serogroups (16% in D+/R+ group; 7% in D/R+ group; and 26% in D+/R group) [77] . These findings illustrate that the burden of delayedonset CMV disease remains high, particularly in the CMV D+/R group [5] .…”

Section: Delayed-and Late-onset CMV Diseasementioning

confidence: 99%

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Current concepts on cytomegalovirus infection after liver transplantation

Lee

Razonable

2010

WJH

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Cytomegalovirus (CMV) is the most common viral pathogen that negatively impacts on the outcome of liver transplantation. CMV cause febrile illness often accompanied by bone marrow suppression, and in some cases, invades tissues including the transplanted allograft. In addition, CMV has been significantly asso ciated with an increased predisposition to allograft rejection, accelerated hepatitis C recurrence, and other opportunistic infections, as well as reduced overall pa tient and allograft survival. To negate the adverse effects of CMV on outcome, its prevention, whether through antiviral prophylaxis or preemptive therapy, is regarded as an essential component to the medical management of liver transplant patients. Two recent guidelines have suggested that antiviral prophylaxis or preemptive therapy are similarly effective in preventing CMV disease in modest-risk CMV-seropositive liver trans plant recipients, while antiviral prophylaxis is the preferred strategy over preemptive therapy for the preven tion of CMV disease in high-risk recipients [CMV-seronegative recipients of liver allografts from CMV-seropositive donors (D+/R-)]. However, antiviral prophylaxis has only delayed the onset of CMV disease in many CMV D+/R-liver transplant recipients, and at least in one study, such occurrence of late-onset primary CMV disease was significantly associated with increased mortality after liver transplantation. Therefore, optimized strategies for prevention are needed, and aggressive treatment of CMV infection and disease should be pursued. The standard treatment of CMV disease consists of intravenous ganciclovir or oral valganciclovir, and if feasible, one should also reduce the degree of immunosuppression. In one recent controlled clinical trial, val ganciclovir was found to be as effective and safe as intravenous ganciclovir for the treatment of mild to mo derate CMV disease in solid organ (including liver) tran splant recipients. In this article, the authors review the current state and the future perspectives of prevention and treatment of CMV disease after liver transplantation.

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“…CMV disease occurs rarely during prophylaxis with oral valganciclovir. Data adapted from references [4,5,77].…”

Section: Indirect CMV Effectsmentioning

confidence: 99%

Section: Delayed-and Late-onset CMV Diseasementioning

confidence: 99%

Section: Delayed-and Late-onset CMV Diseasementioning

confidence: 99%

See 1 more Smart Citation

Current concepts on cytomegalovirus infection after liver transplantation

Lee

Razonable

2010

WJH

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show abstract

“…The efficacy of valganciclovir (and oral ganciclovir) prophylaxis is undermined by the emergence of lateonset CMV disease (Figure 1). In a retrospective study on 203 liver transplant recipients who received valganciclovir 900 mg daily for 3 to 6 mo, the overall incidence of CMV disease was 14% [73] . The incidence varied among the different CMV serogroups (16% in D+/R+ group; 7% in D-/R+ group; and 26% in D+/Rgroup) [73] .…”

Section: Valganciclovir Prophylaxismentioning

confidence: 99%

“…In a retrospective study on 203 liver transplant recipients who received valganciclovir 900 mg daily for 3 to 6 mo, the overall incidence of CMV disease was 14% [73] . The incidence varied among the different CMV serogroups (16% in D+/R+ group; 7% in D-/R+ group; and 26% in D+/Rgroup) [73] . These findings illustrate that the burden of delayed-onset CMV disease remains high particularly in the CMV D+/R-group [5] .…”

Section: Valganciclovir Prophylaxismentioning

confidence: 99%