Vancyclovir prophylaxis – pro
Cytomegalovirus (CMV) infection after solid organ transplantation is one of the most common viral infections, causing significant morbidity and mortality if not treated promptly. Ganciclovir has proven to be effective for the prophylaxis and treatment of CMV. However, oral absorption of ganciclovir is poor. Recently, oral administration of valganciclovir hydrochloride (Valcyte) has been observed to display 10-fold better absorption than oral ganciclovir. Valganciclovir has increasingly been used as prophylaxis against CMV after solid organ transplantation and for severely immunospuressive cehmo regimens.In kidney recipients, oral valganciclovir for 100 days has been shown to be as clinically effective as oral ganciclovir for CMV prevention. In heart recipients, valganciclovir is also presumed to be effective, but data are more limited. Alemtuzumab is an immunosuppressive antibody that depletes normal T cells and B cells. Prophylaxis for herpes virus and Pneumocystis carinii is standard with this agent. Approximately 20% to 25% of patients will experience cytomegalovirus (CMV) reactivation.A very recent randomized trial found CMV prophylaxis to be effective and beneficial in these patients.
Cincinnati Children’s Hospital Medical Center. Evidence-based care guideline for cytomegalovirus prophylaxis following solid organ transplants. Cincinnati (OH): Cincinnati Children’s Hospital Medical Center; 2007 Jul 6. 15 p. [68 references]
Susan O’Brien, Farhad Ravandi, Todd Riehl, William Wierda, Xuelin Huang, Jeffrey Tarrand, Brandi O’Neal, Hagop Kantarjian, and Michael Keating Valganciclovir prevents cytomegalovirus reactivation in patients receiving alemtuzumab-based therapy Blood 111: 1816-1819; prepublished online as DOI 10.1182/blood-2007-03-080010
Paya CV. A randomized, double-blind, double-dummy, active-comparator controlled multi-center study of the efficacy and safety of valganciclovir vs oral ganciclovir for prevention of CMV disease in 372 high-risk (D+/R-) heart, liver and kidney recipients. Program and abstracts of the 42nd Interscience Conference on Antimicrobial Agents and Chemotherapy; September 27-30, 2002; San Diego, California
Ban Hock Tan CMV prophylaxis—to do or not to do, that is the question
NDT Advance Access published on July 1, 2006, DOI 10.1093/ndt/gfl151.
Nephrol. Dial. Transplant. 21: 1757-1761.
Post-Transplant Events E Ayala et al, Valganciclovir is safe and effective as pre-emptive therapy for CMV infection in allogeneic hematopoietic stem cell transplantation Bone Marrow Transplantation (2006) 37, 851–856