ACYCLOVIR IN PREVENTING CYTOMEGALOVIRUS-INFECTION IN KIDNEY-TRANSPLANT RECIPIENTS - A CASE-CONTROLLED STUDY

High dose oral acyclovir has been reported to be effective in preventi ng both cytomegalovirus (CMV) infection and disease in renal transplan t recipients. We conducted a case-controlled study in which 42 cadaver ic kidney transplant recipients were prophylactically treated with hig h dose oral acyclovir for 3 months and compared to historical controls matched for donor/recipient CMV serological status, age, sex, and imm unosuppressive therapy. Before transplantation, study group patients r eceived acyclovir intravenously (500 mg/m2 over 1 hour) which was subs equently given orally (basal dose-800 mg four times daily) from day 2 post-transplantation according to renal function. All patients receive d 14-day induction immunosuppressive therapy with either a polyclonal or a monoclonal antibody together with low dose steroids and azathiopr ine, cyclosporin being introduced at day 10 post-transplantation. Bloo d viral cultures as well as CMV antibody titers were performed in stud y group and control patients in the same laboratory, before transplant ation, weekly until 3 months and then monthly until 6 months. CMV infe ction was defined as a positive blood or bronchoalveolar lavage viral culture or presence of CMV IgM or CMV IgG in a previously seronegative patient. Diagnosis of CMV disease also required the presence of at le ast one concomitant febrile illness, with or without other clinical sy mptoms, not attributable to another pathogen. All patients were follow ed for 3 months. Incidence of both CMV infection and disease was compa red in the two groups using the log-rank test. With regard to CMV infe ction, we found significantly less CMV infection in CMV seropositive p atients (regardless of donor CMV serological status) in the study grou p compared to historical controls (P = 0.005). In contrast, there was no difference between the study group and controls in CMV seronegative recipients who received an organ from a CMV seropositive donor. With regard to CMV disease, we found significantly less CMV disease in CMV seropositive patients (regardless of donor CMV serological status) in the study group compared to historical controls (P = 0.01). On the con trary, there was no difference in CMV seronegative recipients who rece ived an organ from a CMV seropositive donor between study group and tr eated patients. We conclude that high dose oral acyclovir given during 3 months reduces both CMV infection and disease in CMV seropositive r ecipients whatever the CMV serological status of the donor. Such an ef fect was not observed in seronegative renal transplant recipients rece iving a CMV positive kidney. (c) 1993 Wiley-Liss, Inc.