LONG-TERM GANCICLOVIR PROPHYLAXIS FOR SUCCESSFUL PREVENTION OF PRIMARY CYTOMEGALOVIRUS (CMV) DISEASE IN CMV-SERONEGATIVE LIVER-TRANSPLANT RECIPIENTS WITH CMV-SEROPOSITIVE DONORS

Background. We conducted a trial of long-term ganciclovir prophylaxis for prevention of primary cytomegalovirus (CMV) disease in CMV seroneg ative liver transplant recipients with CMV-seropositive donors. Method s. Patients received intravenous ganciclovir at a dose of 6 mg/kg once a day from day 1 to day 30 after transplant, and then at a dose of 6 mg/kg once a day, Monday through Friday, until day 100. Forty-seven co nsecutive patients were evaluated, Due to the primary physician's deci sion or administrative error, 10 patients received less than 7 weeks o f ganciclovir (mean duration, 3 weeks). Results. Four of the 10 (40%) patients who received less than 7 weeks of ganciclovir developed CMV d isease (hepatitis). In contrast, none of the 37 patients given 100 day s of prophylactic ganciclovir developed CMV disease while receiving ga nciclovir. Two patients (5.4%) subsequently developed CMV disease (hep atitis) 21 and 88 days, respectively, after completing their ganciclov ir prophylaxis. Reversible neutropenia in three patients (8.1%) was th e only side effect associated with long term ganciclovir, Complication s from central intravenous catheters did not occur. Conclusions. These results reaffirm the efficacy and safety of long-term ganciclovir pro phylaxis for prevention of primary CMV disease in a large number of hi gh-risk CMV-seronegative liver transplant recipients with CMV-seroposi tive donors.