Two grams daily of oral acyclovir reduces the incidence of cytomegalovirus disease in CMV-seropositive liver transplant recipients

Abstract

Our objective in this study was to determine the efficacy of 2 grams a day of oral acyclovir administered for 16 weeks after transplantation for the prevention of cytomegalovirus (CMV) infection and disease in CMV-seropositive liver transplant recipients. Seventythree adult liver transplant recipients, seropositive for CMV, were I randomized to receive either 2 grams a day of oral acyclovir for 16 weeks after transplantation or no prophylaxis. The incidence of CMV disease was significantly lower in the acyclovir group ( 5 YO) than in the control group (27 YO; P < 0.05). By log-rank analysis, the differences in the probability of presenting CMV disease over the first 16 weeks and over the 1st year were also significant ( P < 0.05). We conclude that 2 grams a day of oral acyclovir provides effective prophylaxis against CMV disease in CMV-seropositive liver transplant recipients.

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

“…Similarly, high-dose acyclovir with targeted intravenous ganciclovir administration during antilymphocyte antibody therapy appears to be an effective strategy against CMV reactivation in those receiving either a kidney or kidney-pancreas allograft (35,417). Results of similar studies done on liver transplant recipients have been disappointing (284,423,497), although one study suggested a beneficial effect with 2 g of oral acyclovir a day taken by CMV-seropositive liver transplant recipients for 16 weeks (145). While acyclovir is not particularly active against CMV in vitro, it is possible that the achievable cellular levels will inhibit the small amounts of replicating virus that are present as it emerges from latency.…”

“…Current prophylactic approaches vary widely among different transplant programs (5,8,18,26,72,104,105,143,145,172,232,236,273,284,299,319,382,396,423,497) (Table 5). Reasons for the discrepancies reflect the absence of large, multicenter, randomized trials evaluating the efficacy of countless preventive strategies.…”

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

“…Conceptual presentation of the risk of late-onset CMV disease with antiviral prophylaxis in organ transplant recipients; data compiled from [1][2][3][4][5][6][7]19,20,35,36]. The risk of late-onset CMV is low (0-5%) if a relatively less potent antiviral agent (acyclovir) is employed for a prolonged period [5,6] or if a potent drug (valganciclovir) is used for a short period (0%) as in preemptive therapy [19,20,22].…”

Valacyclovir for the Prevention of Cytomegalovirus Disease after Renal Transplantation

“…17 The availability of effective therapy [18][19][20] has reduced this figure significantly among renal-transplant recipients, 8,21 but the increased morbidity and overall costs of transplantation associated with CMV persist. 10,22 High-dose oral acyclovir is well tolerated, but prophylactic use of acyclovir has not gained wide acceptance 9 despite the fact that it reduces the risk of CMV disease among recipients of renal [23][24][25] and other solid-organ [26][27][28] transplants. The limited efficacy of acyclovir may be a result of its low oral bioavailability and the low in vitro sensitivity of CMV to the drug.…”