COMPARISON OF INTRAVENOUS GANCICLOVIR FOLLOWED BY ORAL ACYCLOVIR WITHINTRAVENOUS GANCICLOVIR ALONE FOR PREVENTION OF CYTOMEGALOVIRUS AND EPSTEIN-BARR-VIRUS DISEASE AFTER LIVER-TRANSPLANTATION IN CHILDREN

A randomized trial was performed to compare the sequential use of 2 we eks of intravenous ganciclovir (10 mg/[kg.d]) followed by 50 weeks of high-dose oral acyclovir (800 mg/m(2) four times daily) with 2 weeks o f intravenous ganciclovir alone as prophylaxis for cytomegalovirus (CM V) and Epstein-Barr virus (EBV) disease after pediatric liver transpla ntation. CMV disease was diagnosed for seven of 24 patients treated wi th ganciclovir followed by high-dose oral acyclovir compared with two of 24 children treated with ganciclovir alone (P = .048). Similarly, t he rate of CMV disease among high-risk patients (CMV-positive donor/CM V-negative recipient) treated with the combination regimen was higher than that among high-risk patients treated with ganciclovir alone (fou r [57%] of seven vs. zero of five, respectively; vs P < .05). The rate of EBV disease among patients treated with the combination regimen (e ight [33%] of 24) was similar to that among patients treated with ganc iclovir alone (five [21%] of 24; P = not significant). We conclude tha t sequential prophylaxis with 2 weeks of intravenous ganciclovir follo wed by 50 weeks of high-dose oral acyclovir did not decrease the frequ ency of CMV or EBV disease after pediatric liver transplantation when compared with 2 weeks of intravenous ganciclovir alone.