Allograft rejection predicts the occurrence of late-onset cytomegalovirus (CMV) disease among CMV-mismatched solid organ transplant patients receiving prophylaxis with oral ganciclovir

The natural history of cytomegalovirus (CMV) disease associated with solid organ transplantation has been modified as a result of the widespread use o f antiviral prophylaxis. Anecdotal reports have indicated a reduction of CM V disease at the expense of its later occurrence after completion of gancic lovir prophylaxis. The present study investigated the occurrence of CMV dis ease and its risk factors among 37 liver and kidney transplant recipients w ith CMV D+/R- status who received oral ganciclovir during the first 100 day s posttransplantation. CMV disease occurred in 9 patients (24.3%) at a medi an of 144 days posttransplantation (range, 95-190 days). Allograft rejectio n was found to be strongly associated with the occurrence of late-onset CMV disease (risk ratio, 6.6; 95% confidence interval, 1.4-32.1; P = .02). Thu s, CMV D+/R- solid organ transplant recipients receiving 3 months of oral g anciclovir who develop allograft rejection during the period of antiviral p rophylaxis may benefit from extended and/or enhanced antiviral prophylaxis to prevent late-onset CMV disease.