ACYCLOVIR PROPHYLAXIS FOR CYTOMEGALOVIRUS DISEASE IN HIGH-RISK RENAL-TRANSPLANT RECIPIENTS - IS IT EFFECTIVE

Cytomegalovirus (CMV) is a significant cause of post-transplantation m orbidity and mortality in renal transplant recipients. The risk of CMV infection is between 60 and 88% in CMV seronegative patients who rece ive kidneys from CMV seropositive donors (D-, R(-)). In order to evalu ate the efficacy of oral acyclovir in prevention of CMV infection afte r transplantation we retrospectively reviewed the records of 25 patien ts (D-, R(-)) who were transplanted between January 1993 and December 1995. Eighteen of 25 patients received prophylaxis with variable doses of acyclovir (600 to 4000 mg/day, adjusted for their renal function) for 4 to 7 months. CMV disease was defined as fever (greater than or e qual to 38 degrees C) for at least three days which could not be attri buted to other causes with positive cultures or seroconversion for CMV , and presence of either leukopenia, pneumonitis, gastroenteritis or e levated liver enzymes. Twelve of the 18 patients (66.6%) who received acyclovir prophylaxis developed CMV disease. Seven patients were hospi talized and treated with i.v. ganciclovir. One patient died from CMV p neumonia associated with invasive fungal infection five months after t ransplantation. Of the 7 patients who did not receive prophylactic acy clovir 5(71.4%) developed CMV disease (2 patients were hospitalized an d treated with ganciclovir). Our results failed to confirm the efficac y of oral acyclovir as a prophylaxis against CMV disease in a small gr oup of high-risk patients. We conclude that the other strategies shoul d be tested.