Pre-emptive oral ganciclovir can reduce the risk of cytomegalovirus disease in liver transplant recipients

Abstract

A cohort of 65 liver transplant recipients was prospectively monitored with qualitative polymerase chain reaction (PCR) in plasma. The first 25 patients did not receive prophylaxis. From a consecutive group of 40 recipients, 11 high-risk patients donor CMV-seropositive/receptor CMV-seronegative (D+/R-), persistent CMV replication) received pre-emptive oral ganciclovir (1000 mg three times daily), when a marker of risk was identified, until day 90. The overall incidence of cytomegalovirus (CMV) disease at six months was 20% (five of 25 patients) in the non-prophylaxis group and 2.5% (one of 40 patients) in the group treated with pre-emptive oral ganciclovir (relative risk, 0.11; 95% confidence interval; 0.01-0.96; P = 0.04). The PCR sensitivity for detecting CMV disease was 80%, the specificity was 90%, and the positive and negative predictive values were 66% and 95%, respectively. Adverse events, graft rejection and survival were similar between groups. We conclude that pre-emptive oral ganciclovir in high-risk patients can reduce the risk of CMV disease.

Preventing Post–Organ Transplantation Cytomegalovirus Disease with Ganciclovir: A Meta‐Analysis Comparing Prophylactic and Preemptive Therapies

“…Subgroup analyses were performed on studies using each of these methods, and the analyses were compared to determine whether either method would significantly affect outcome data. [39][40][41][42][43][44][45][46][47] met the inclusion criteria for analysis (figure 1). One prospective head-to-head trial was identified that is not included in the meta-analysis, but it will be discussed later [13].…”

Antiviral drugs for cytomegalovirus in transplant recipients: advantages of preemptive therapy

“…Preemptively administered oral ganciclovir at dosages ! 3 gm/day has also been shown to be effective in reducing the risk of CMV disease [20,30,31]. In liver transplant recipients, preemptive oral ganciclovir was associated …”

“…Long-term use of valganciclovir as prophylaxis appears to pose a higher risk (5. [30]. Oral ganciclovir for 6 weeks initiated upon detectable CMV antigenemia was effective in preventing CMV disease in liver transplant recipients [20].…”

Quantitative pp65 antigenemia in the diagnosis of cytomegalovirus disease: prospective assessment in a cohort of solid organ transplant recipients

“…CMV DNA in the follow-up of a liver recipients cohort, obtained SZ80%, EZ90%, PPVZ66% and NPVZ95%. 25 Similarly, Pellegrin et al when comparing pp65Ag with five molecular techniques for detection of CMV DNA in a cohort of renal allograft recipients, obtained even higher S (100 vs. 91%), E (61 vs. 47%), PPV (61 vs. 50%) and NPV (100 vs. 90%) of pp65Ag with respect to PCR. 20 Many of these authors conclude that techniques detecting CMV DNA could improve the results of pp65Ag, especially, when a delay in the sample processing occurs, due to the higher stability of CMV DNA compared with pp65Ag; 14,20 nevertheless, the handicap of PCR based molecular techniques rests on the difficulties in comparing the results obtained with different in-house developed PCR, thus many authors agree on the need of standardized methods in order to exactly assess the diagnostic value of molecular techniques.…”