Preemptive Ganciclovir Therapy in Cytomegalovirus-Seropositive Renal Transplants Recipients

Conti, David; Freed, Brian M.; Singh, Tejinder P.; Gallichio, M; Gruber, Scott A.; Lempert, Neil

doi:10.1001/archsurg.1995.01430110075014

Cited by 71 publications

(38 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…For viral prophylaxis to be efficacious, the potency of antiviral strategies needs to be proportionate to the intensity of the anti-rejection regimen. As demonstrated in renal transplant recipients in whom antithymocyte globulin therapy is a risk factor for CMV disease, the concomitant administration of intravenous ganciclovir decreased the incidence of CMV disease (76,197). This may potentially provide a cost-effective strategy of significantly improving the outcome of organ transplantation in CMV-seropositive patients.…”

Section: Preemptive Prophylaxismentioning

confidence: 92%

“…The ideal scenario consists of the performance of a relatively inexpensive surveillance test to detect the presence of an early marker for CMV disease, with a quick turnaround time, at the period when the risk of viral acquisition after organ transplantation is at the highest (i.e., 2 to 6 weeks). This is followed by the initiation of treatment with a highly effective anti-CMV agent that is taken orally by those identified with a positive disease marker (76,110,143,197,300,423,447,453) (Table 7).…”

Section: Preemptive Prophylaxismentioning

confidence: 99%

See 1 more Smart Citation

New Strategies for Prevention and Therapy of Cytomegalovirus Infection and Disease in Solid-Organ Transplant Recipients

Sia¹,

Patel²

2000

Clinical Microbiology Reviews

220

181

View full text Add to dashboard Cite

Section: Preemptive Prophylaxismentioning

confidence: 92%

Section: Preemptive Prophylaxismentioning

confidence: 99%

New Strategies for Prevention and Therapy of Cytomegalovirus Infection and Disease in Solid-Organ Transplant Recipients

Sia¹,

Patel²

2000

Clinical Microbiology Reviews

220

181

View full text Add to dashboard Cite

“…In contrast, the body of evidence supporting pre-emptive therapy is comparatively small. A number of randomised trials of 'pre-emptive therapy' in solid-organ transplant recipients address its effectiveness during administration of antilymphocyte treatment for rejection which, as previously mentioned, we believe should be classified within the category of prophylactic therapy [21][22][23][24][25]. There is only one randomised trial comparing pre-emptive therapy with prophylaxis in solid-organ transplant recipients [26].…”

Section: The Evidence For Reducing CMV Diseasementioning

confidence: 99%

Prophylaxis for CMV should now replace pre‐emptive therapy in solid organ transplantation

Hart

Payá

2001

Reviews in Medical Virology

View full text Add to dashboard Cite

Cytomegalovirus is a significant cause of morbidity and mortality in transplantation. Controversy exists concerning whether prophylactic or pre-emptive therapy is the optimal strategy for preventing CMV disease. In addition, CMV impacts the transplanted graft, transplant recipient and transplant programme beyond just causing CMV disease; thus questioning whether 'asymptomatic' CMV replication should also be prevented. In this Forum article, prophylactic therapy is advocated as the preferred approach for preventing CMV disease. Prophylactic therapy has a large body of supportive controlled clinical studies demonstrating its efficacy and cost effectiveness. In addition, prophylactic therapy has the benefit of preventing other herpes viruses and other opportunistic superinfections by reducing the immunosuppressive effects of CMV. Moreover, a small but growing body of information suggests that prophylactic therapy may also have a beneficial effect on organ outcomes, including rejection. In contrast, pre-emptive therapy is limited by its reliance on intensive surveillance, which presents logistical difficulties and requires perfect patient compliance. Ambiguity still exists concerning the best surveillance method and its effect on patient-care costs. Each proposed diagnostic approach has limitations, which are affected by the prevalence of CMV in the population studied, the particular assay employed, and the frequency of surveillance. The suggested benefits of pre-emptive therapy, such as decreased cost, fewer adverse medication effects and less antiviral resistance have not been adequately proven in head-to-head clinical studies. We therefore support the proposition that transplant patients at risk for any level of CMV replication will significantly benefit from effective antiviral prophylaxis.

show abstract

“…Furthermore, CMV is associated with an increased risk of bacterial and fungal infections (11,13,31,32) and graft rejection (8,24), increased health care costs (9,18), and decreased survival (7,10) in transplant recipients. While treatment of disease with specific anti-CMV drugs reduces the severity and mortality of CMV disease in transplant recipients (17,29), prophylaxis and preemptive therapy are more effective in preventing CMV disease (5,6,15,21). The success of preemptive therapy in particular is dependent upon the availability of sensitive, specific, and timely diagnostic tests for CMV infection.…”

mentioning

confidence: 99%

Distinguishing Cytomegalovirus (CMV) Infection and Disease with CMV Nucleic Acid Assays

et al. 2002

View full text Add to dashboard Cite

Human cytomegalovirus (CMV) continues to be a significant cause of morbidity and mortality among transplant recipients. Molecular assays have been developed for the detection and quantification of CMV nucleic acid. In evaluating the clinical utility of these assays, correlations with clinical outcome are essential. The Amplicor CMV Monitor and NucliSens CMV pp67 tests were compared to the CMV antigenemia assay for 45 transplant recipients and 1 patient with Wegener's granulomatosis. Twenty-three patients remained antigenemia negative throughout the monitoring period, none of whom developed CMV disease. In this patient group, both the Amplicor and NucliSens assays showed very high specificity; only 1 of the 324 specimens assayed by NucliSens and none of the 303 specimens assayed by Amplicor were positive. Twenty-three patients were antigenemia positive during the monitoring period, 12 of whom developed 13 episodes of symptomatic CMV disease. In this patient group, the NucliSens assay was positive at or before the development of symptoms in 12 of the 13 episodes of CMV disease. All eight patients with symptomatic CMV disease who were tested by the Amplicor assay were positive at or before the development of disease. For the 11 asymptomatic patients, the NucliSens assay was positive less frequently than the antigenemia or Amplicor assays. The NucliSens assay was more likely to be positive at higher antigenemia or viral load levels. Both the NucliSens and Amplicor assays appear to have clinical utility in monitoring patients for CMV disease.

show abstract

Preemptive Ganciclovir Therapy in Cytomegalovirus-Seropositive Renal Transplants Recipients

Abstract: Preemptive ganciclovir therapy provides a cost-effective approach toward significantly improving the outcome of renal transplantation in CMV-seropositive patients treated with ALA.

Cited by 71 publications

References 17 publications

New Strategies for Prevention and Therapy of Cytomegalovirus Infection and Disease in Solid-Organ Transplant Recipients

New Strategies for Prevention and Therapy of Cytomegalovirus Infection and Disease in Solid-Organ Transplant Recipients

Prophylaxis for CMV should now replace pre‐emptive therapy in solid organ transplantation

Distinguishing Cytomegalovirus (CMV) Infection and Disease with CMV Nucleic Acid Assays

Contact Info

Product

Resources

About