QUESTIONABLE BENEFIT OF PROPHYLACTIC ACYCLOVIR IN RENAL-TRANSPLANT RECIPIENTS AT HIGH-RISK FOR CYTOMEGALOVIRUS DISEASE

Prophylactic acyclovir may help to prevent or ameliorate cytomegalovir us (CMV) disease in high-risk renal transplant recipients who are CMV- seronegative pre-transplant and receive a kidney from a CMV-seropositi ve donor. We evaluated the efficacy of prophylactic acyclovir by compa ring the incidence and severity of CMV disease in high-risk acyclovir- treated patients (n = 28) with that of historical controls (n = 21). A cyclovir was administered for 12.0 +/- 4.9 weeks (800 to 3200 mg/day p .o. with dose adjusted for renal function). Patients and controls did not differ with respect to age, sex, the number of AB and DR major his tocompatibility mismatches, panel-reactive antibody status, or diabete s. Clinical CMV disease (fever with positive blood culture/antigen or four-fold rise in antibody titer) developed in 50% of acyclovir-treate d patients and in 71% of controls (p = 0.13). When adjustment was made for possible differences between acyclovir patients and controls usin g logistic regression, the effects of acyclovir on CMV disease were no t statistically significant. The severity of CMV disease measured by t he duration of fever, days of hospitalization, white blood count nadir , and changes in hepatic enzymes were similar between the groups. Thes e results suggest that acyclovir had little effect on the incidence an d severity of CMV disease in these high-risk renal transplant recipien ts, and that additional randomized controlled trials are needed to def ine the role of acyclovir prophylaxis.