Ganciclovir - An update of its use in the prevention of cytomegalovirus infection and disease in transplant recipients

Ganciclovir is a nucleoside guanosine analogue which incorporates ganciclov ir triphosphate (the active moiety) into DNA during elongation, thereby inh ibiting Viral replication. Comparative studies of pre-emptive and prophylactic ganciclovir therapies i n bone marrow transplant (BMT) recipients have shown similar rates of cytom egalovirus (CMV) infection, disease and patient mortality. Long term prophylaxis with either oral, or sequential intravenous/oral, gan ciclovir has shown efficacy in renal allograft recipients, including high r isk patients or those receiving antilymphocyte antibody therapy. A prelimin ary study indicates that ganciclovir is more efficacious than aciclovir in paediatric patients. Both oral and intravenous prophylactic ganciclovir regimens have shown effi cacy compared with no antiviral treatment in lung transplant recipients: in itial reports have shown similar efficacy between pre-emptive and prophylac tic ganciclovir. Oral ganciclovir monotherapy is as efficacious as sequenti al intravenous/oral ganciclovir therapy in liver transplant recipients. Pre -emptive treatment was equally as effective as long term ganciclovir prophy laxis in high risk patients. Ganciclovir prophylaxis for 4 weeks appears ineffective in heart allograft recipients treated with antithymocyte globulin, Long term sequential intrav enous/oral ganciclovir therapy has shown greater efficacy in preventing CMV disease than sequential ganciclovir/aciclovir therapy in these patients. I nitial reports indicate that pre-emptive therapy may be beneficial in this patient group, although this remains to be determined.