Prophylaxis of cytomegalovirus infection in renal transplantation: new data for an old problem.

(including tissue-invasive CMV disease) in 616 ganciclovir; prophylaxis; renal transplantation; recipients of cadaveric renal allografts [2]. Two hun-valacyclovir dred and eight patients were assigned to the CMV high-risk group (CMV positive donor and a CMV negative receptor); this group was called the sero-negative group. Valacyclovir in a dose of 2 g q.i.d. Introduction (adjusted for renal function) was started in one group of 102 patients within 72 h after receiving a cadaveric New reports in the literature about the effective use of renal allograft and continued for 90 days. One hundred valacyclovir (Zelitrex°, Valtrex°, Glaxo Wellcome) as and six recipients served as a control group and prophylactic treatment for cytomegalovirus (CMV) received matching placebo in a similar regimen, also infection in renal transplantation, have prompted us for 90 days. The 408 remaining patients were consid-to update our recent Editorial Comment (Nephrol Dial ered at moderate risk for CMV disease (CMV positive Transplant 13: 3012–3016, 1998) on this interesting recipients, designated as the sero-positive group) and topic. Valacyclovir not only reduces the incidence of were divided into two equal groups; a valacyclovir active CMV infection and CMV disease in renal trans-treated group and a placebo (control) group. plant patients, but it also seems to exert a beneficial Treatment in each of the latter groups was respectively effect on the incidence of acute allograft rejection, the same as described above for the high-risk patients. other herpesvirus infections and non-viral infections. The primary end-point was presumptive CMV dis-These additional properties of valacyclovir warrant ease defined as fever occurring in a patient for three a critical analysis of the published data in the light of consecutive days plus leukopenia, thrombocytopenia the old and new available information about ganciclo-or symptoms related to specific organ involvement vir prophylaxis in renal transplantation. (pneumonitis, hepatitis, …) or constitutional symptoms (myalgia). In an abstract presented at the International Congress on Infectious Diseases in May Valacyclovir trials 1998, the same authors proposed a definition of CMV disease [3]. Leucopenia was defined as more than two Valacyclovir is an amino acid ester prodrug of acyclovir consecutive leucocyte counts of ∏4000/mm3 or a 30% that is rapidly and almost completely hydrolysed to decrease from baseline; thrombocytopenia was defined acyclovir and has an oral bioavailability of 54% comas more than two consecutive platelet counts of pared to 20% for acyclovir. The plasma AUC of ∏100 000/mm3 or a 30% decrease from baseline. acyclovir …