PREEMPTIVE TREATMENT FOR THE PREVENTION OF CYTOMEGALOVIRUS DISEASE - IN LUNG AND HEART-TRANSPLANT RECIPIENTS

Background. Rapid quantifiable diagnostic techniques for the diagnosis of cytomegalovirus (CMV) infection may predict patients at risk of CM V pneumonitis and allow preemptive antiviral treatment, Methods, Using CMV antigenemia as a prospective surveillance technique for CMV infec tion, we compared the outcome of preemptive treatment (PT) with gancic lovir, 10 mg/kg/day for 21 days directed by ''high levels'' of CMV ant igenemia (PT group, n=19), with the outcome in a group of historical c ontrols (n=18) treated with ganciclovir when CMV illness occurred, Gre ater than 50 antigen-positive cells per 2x10(5) polymorphonuclear leuk ocytes was considered to be high-level antigenemia, Results. Nine of t he 18 controls developed high-level CMV antigenemia at a median of 33 days (range: 13-65 days) and 5 of the 9 developed CMV disease, Ten of the 19 PT group had high levels of CMV antigenemia detected at a media n of 47 days (range: 20-63 days) and were given ganciclovir; none deve loped CMV disease. There was a significantly lower incidence of CMV di sease in the PT group in comparison to controls (0 of 19 vs. 5 of 18: P=0.019). Conclusion, We have reduced the incidence of CMV disease usi ng preemptive treatment, and because of a 100% negative predictive val ue, we omitted unnecessary antiviral prophylaxis for many at-risk pati ents.