Intravenous ganciclovir prophylaxis for cytomegalovirus in heart, heart-lung, and lung transplant recipients

Abstract

Cytomegalovirus (CMV) disease has had a significant clinical impact on the heart, heart-lung and lung transplant recipients in our centre. CMV disease has been so severe with CMV antibody-negative heart-lung transplant patients receiving organs from CMV antibodypositive donors (CMV-mismatched patients) that in 1986 we adopted the policy of not transplanting CMV-positive organs into CMVnegative heart-lung or lung recipients. In December 1992, we instituted a policy of providing intravenous ganciclovir (5 mg/kg twice a day for 28 days) during the immediate postoperative period for CMV-mismatched heart recipients and CMV antibody-positive heart-lung and lung patients, who have been the patients at greatest risk of severe CMV disease in our centre. A placebo group was not employed because of ethical considerations, ganciclovir having been shown to be effective for the treatment of CMV infections among transplant patients. Compared with a historical control group of patients receiving no prophylaxis, prophylactic ganciclovir reduced the incidence of CMV infection (39 YO vs 91 %, P = 0.0006) and CMV disease (17 % vs 74 Yo, P = 0.0004) among CMV antibody-positive heart-lung recipients. Prophylactic ganciclovir did not significantly reduce the incidence of CMV infection or disease among heart or isolated lung recipients. Ganciclovir was well tolerated, with few adverse reactions. In the case of heart-lung transplant patients, one month of intravenous prophylactic ganciclovir significantly reduced the incidence of both CMV infection and disease when compared with patients who received no prophylaxis. With the lung transplant and heart transplant patients, there were no significant differences between the prophylaxis and nonprophylaxis groups, although there was a consistent trend towards less infection and disease in the prophylaxis groups.

Following Universal Prophylaxis with Intravenous Ganciclovir and Cytomegalovirus Immune Globulin, Valganciclovir is Safe and Effective for Prevention of CMV Infection Following Lung Transplantation

“…Several prophylactic strategies have been assessed in lung transplant recipients, including the efficacy of i.v. GCV for 28 (10), and 35 days (22). Brumble et al (8) reported on the use of a unique 2-week delayed i.v.…”

“…Several prophylactic regimens have been studied in lung transplant recipients, including i.v. and oral GCV alone or in combination with CMV hyperimmune globulin (CMV-IVIG) (7)(8)(9)(10)(11)(12). However, the optimal prophylactic strategy in lung transplant recipients remains controversial; the appropriate regimen and duration of therapy remains unclear.…”

Efficacy and Safety of Low‐Dose Valganciclovir for Prevention of Cytomegalovirus Disease in Renal Transplant Recipients: A Single‐Center, Retrospective Analysis

“…4 Conversely, recent evidence indicates that the donor positive/recipient positive (D+/R+) group may have the worst long-term graft and patient survival. 11 The reason for this not entirely clear, although it is likely that the D+/R+ patients may have exposure to multiple strains of the virus, resulting in a CMV superinfection. Donor negative/recipient positive (D-/R+) patients tend to have a low risk of developing CMV disease; however, the risk of viral reactivation always must be considered.…”

Ganciclovir-Resistant Cytomegalovirus Infections among Lung Transplant Recipients Are Associated with Poor Outcomes despite Treatment with Foscarnet-Containing Regimens

“…The optimal preventive regimen against CMV infection following lung transplantation remains undefined, but most programs employ universal antiviral prophylaxis (2). Most prophylaxis studies in lung transplant recipients have employed ganciclovir, alone or in combination with CMV hyperimmunoglobulin G (3)(4)(5)(6)(7)(8)(9)(10). Valganciclovir, an oral prodrug that achieves ganciclovir concentrations comparable to those of intravenous (i.v.)…”