EFFECT OF PROPHYLACTIC GANCICLOVIR ON CYTOMEGALOVIRUS-INFECTION IN RENAL-TRANSPLANT RECIPIENTS

Cytomegalovirus (CMV) infection is the most frequent infectious compli cation observed in renal transplant recipients and induces a significa nt morbidity in these patients due to CMV disease itself and to associ ated renal dysfunction or opportunistic superinfection. In order to ev aluate the effect of ganciclovir prophylaxis we conducted an open-labe l prospective randomized study of ganciclovir administration in CMV se ronegative recipients of a renal allograft from CMV seropositive donor s. Ganciclovir (5 mg/kg b.i.d./day for 14 days) was started on day 14 after transplantation. Thirty-two patients were included in this study (I 5 in the control group, 17 in the ganciclovir group). There was no significant difference between the two groups for age, immunosuppress ive regimen, number of rejection, steroid pulses, and OKT3 treatments. Renal and patient outcomes were similar in both groups. The rate of C MV infection and CMV disease were similar in both groups (80% and 73.3 % in the control group versus 70.6% and 47.1% in the ganciclovir group ; P=NS). Less severe CMV disease was observed in the ganciclovir group compared to controls. The delay between transplantation and CMV infec tion was significantly longer in the ganciclovir group compared to con trol group (68.1 +/- 5.1 versus 44.0 +/- 5.2 days, P < 0.005). Twelve control patients (80%) versus nine (53%) of the ganciclovir group requ ired curative treatment with ganciclovir after the diagnosis of CMV in fection (NS). All the patients recovered from CMV disease and no signi ficant side-effect was observed during ganciclovir administration. We conclude that prophylactic ganciclovir administration from day 14 to d ay 28 after transplantation does not prevent CMV infection in seronega tive recipients of renal allograft from seropositive donors but prolon gs the incubation period. Longer prophylaxis by ganciclovir in these p atients should be tested.