The CARI guidelines. CMV disease and kidney transplant: treatment of cytomegalovirus disease in renal transplant recipients.

We suggest ganciclovir by IV administration be the treatment of choice for moderate-severe Cytomegalovirus (CMV) disease and patients with gastrointestinal involvement where drug absorption may be impaired. Mild CMV disease in adults may be treated with either oral valganciclovir or IV ganciclovir (Level II evidence, single study). Drug dose should be reduced in patients with renal impairment. Consider reduction in immunosuppressive therapy. We suggest graft function be monitored closely as acute rejection may occur. Ganciclovir and valganciclovir may cause leukopaenia and increase serum creatinine. We suggest treatment should continue for 2-3 weeks or until CMV-DNA is not detectable (Level III evidence). Persistence of CMV-DNA after 21 days is associated with disease recurrence. -infection or ganciclovir resistance (Level III evidence). Foscarnet and cidofovir remain second-line agents (Level III evidence).