EFFICACY OF ORAL GANCICLOVIR IN PREVENTION OF CYTOMEGALOVIRUS-INFECTION IN POST-KIDNEY TRANSPLANT PATIENTS

Unlike parenteral gancicovir, the efficacy of oral ganciclovir in the prevention and treatment of cytomegalovirus (CMV) infection in kidney transplantation has not been well documented. This study prospectively evaluated the episodes of CMV infection within the first nine months after transplantation in renal transplant recipients treated prophylac tically with oral ganciclovir (750 mg twice a day) over a period of 3 months (oral ganciclovir, N=22), compared with patients randomly assig ned as controls (controls, N=22) who did not receive any anti-viral pr ophylaxis. Diagnosis of CMV infection at presentation included serolog ical determination of CMV-specific immunoglobulin M antibodies, CMV im munofluorescence assay [standard culture tube and shell vial] (blood) and virus isolation (urine and tissue). CMV infection occurred in one patient (5%) in the oral ganciclovir group and 6 patients (27%) in the control, group (p<0.05). The episodes of biopsy proven allograft reje ctions were 5% (1/21) and 18% (4/22) in the oral ganciclovir and contr ol groups, respectively. Except for one, none of these patients develo ped CMV infection either before or after rejection(s). Controlling for the reason (induction or treatment of rejection) for using cytolytic antibody therapies, we found that prophylactic oral ganciclovir was pr otective against CMV infection (adjusted risk reduction 0.83; 95% conf idence interval, 0.33-0.98; p<0.05). Neither, the CMV status of donors and recipients nor the treatment for acute rejection had any signific ant impact on the occurrence of CMV infections. Our results show that oral ganciclovir is an effective and well tolerated therapy in the pre vention of CMV infection in renal transplant patients.