Efficacy and cost effectiveness of oral ganciclovir in the prevention of cytomegalovirus disease after lung transplantation

Background. Cytomegalovirus is the single most frequent pulmonary pathogen in lung transplant recipients who survive at least 2 weeks. Patients at inc reased risk are either seropositive or have received an allograft from a do nor with latent infection. Morbidity and mortality caused by cytomegaloviru s dis ease is still considerably high. Methods. In an open, comparative study, we evaluated the efficacy, toleranc e, and cost effectiveness of postoperative ganciclovir prophylaxis: intrave nous dose of 2x5 mg/kg/day for 14 days, followed by either intravenous dose s of 5 mg/kg/day (five patients), or oral doses of 3 x 1000 mg (nine patien ts) up to 90 days. Oral ganciclovir was continued until prednisone was tape red below 15 mg/day, Prophylaxed groups were compared with a historical con trol (eight patients) in respect to cytomegalovirus disease, in-hospital st ay, overall costs, and survival. Follow-up times and the net state of immun osuppressive therapy between groups were comparable. Results. Six (75%) of the non-prophylaxed patients developed cytomegaloviru s disease compared to none in the intravenous and one in the oral ganciclov ir group (P=0.013). The non-prophylaxed patients had a longer cytomegalovir us-related in-hospital stay (P=0.018) and nonsignificantly higher cytomegal ovirus-related costs. Bronchiolitis obliterans syndrome was less frequent w ith prophylaxis (P=0.039), and survival tended to be better (P=0.072). The only adverse effect was a subclavian vein thrombosis in the intravenous gan ciclovir group. Conclusions. In lung transplant recipients, ganciclovir prophylaxis, either intravenous or oral, is safe, well tolerated, and effective in preventing cytomegalovirus disease. Moreover, ganciclovir prophylaxis seems likely to reduce the incidence of bronchiolitis obliterans syndrome. The oral formula tion might be preferable because its convenience and possibly lower costs.