R. Speich et al., Efficacy and cost effectiveness of oral ganciclovir in the prevention of cytomegalovirus disease after lung transplantation, TRANSPLANT, 67(2), 1999, pp. 315-320
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.