Low-dose valaciclovir prophylaxis against cytomegalovirus disease in renal transplant recipients

• Published in: Transplant international 2003-10, Vol.16 (10), p.726-729
• Main Authors: REDDY, Srikanth P, HANDA, Ashok, LIAMCHIN TAN, DEVANEY, Andrea, HUGHES, David, MASON, Phillip, FRIEND, Peter J, DARBY, Christopher R
• Format: Article
• Language: English
• Subjects: Acyclovir - analogs & derivatives; Acyclovir - therapeutic use; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antiviral Agents - therapeutic use; Biological and medical sciences; Clinical death. Palliative care. Organ gift and preservation; Cytomegalovirus Infections - prevention & control; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents - therapeutic use; Kidney Transplantation - physiology; Living Donors; Male; Medical sciences; Postoperative Complications - prevention & control; Postoperative Complications - virology; Prodrugs - therapeutic use; Reoperation; Retrospective Studies; Tissue Donors; Valine - analogs & derivatives; Valine - therapeutic use
• ISSN: 0934-0874; 1432-2277
• DOI: 10.1007/s00147-003-0612-4

High-dose valaciclovir at up to 8 g/day has been shown to be effective in prophylaxis against cytomegalovirus (CMV) disease in renal transplant recipients. We report our experience with low-dose valaciclovir prophylaxis of up to 3 g/day, adjusted to creatinine clearance. A group of patients at high risk of developing CMV disease who received prophylaxis were selected as the study group. This included all CMV-positive patients who received antilymphocyte therapy (R+, n=20) and all CMV-negative recipients of CMV-positive organs (D+R-, n=15). D+R- patients receiving antilymphocyte therapy were excluded, as most of the patients in the control group had received ganciclovir prophylaxis. A historical control group was used, which consisted of patients who did not receive prophylaxis. Low-dose valaciclovir prophylaxis resulted in a statistically significant decrease (8.5 vs 37%, P=0.004) in CMV disease in the study group at 6 months. On subgroup analysis the decrease was statistically significant only in the R+ group (5 vs 45%, P=0.003), not in the D+R- group (13.3 vs 26.6%, P=0.651). Low-dose valaciclovir prophylaxis seems to be adequate for R+ patients receiving antilymphocyte therapy. The role of low-dose valaciclovir prophylaxis needs to be assessed further in a prospective trial.