Late CMV Disease and/or Recurrence in Renal Transplants Recipients with Prolonged Oral Ganciclovir Prophylaxis

Background/Aim: Oral ganciclovir effectively prevents CMV disease, but late-onset CMV disease is increasingly observed in pancreas-kidney and bone-marrow transplants recipients, specially with long-term prophylaxis. Then, the aim of this study was to verify if prolonged administration of oral ganciclovir prophylaxis could induce late CMV recurrence or disease in renal transplant recipients Material/Methods: 64 renal transplant recipients with a follow-up of 1 year were divided in two groups: 27 patients of short-term group (ST-group) treated 1-2 months with oral GCV prophylaxis, and 37 patients of long-term group (LT-group) treated 3-4 months. CMV Antigenemia and PCR were performed weekly until 4 first months after transplant, and monthly until the end of the study. Results: At 4 months, CMV replication was similar in ST-group and LT-group (33% vs. 32.4%, respectively), but at 1 year, was found more frequently in ST-group than in LT-group (77.8% vs 51.4%, respectively, p=0.03). CMV disease was similar in both (2 patients in each group). CMV infection appeared at same time after transplant in both groups (at 6 months after transplant), but disease was earlier in ST-group than in LT-group (100 days vs. 144 days respectively), in each case independently of GCV time. Recurrence of CMV disease was not found. Conclusions: Prolonged oral GCV reduced CMV replication, but not CMV disease rate. The administration of prolonged oral GCV delayed CMV disease. CMV replication was observed during GCV treatment. In presence of GCV prophylaxis, clinical and virological follow-up should be performed more than 120 days (4 months after transplant).