PREEMPTIVE GANCICLOVIR THERAPY IN CYTOMEGALOVIRUS-SEROPOSITIVE RENAL-TRANSPLANTS RECIPIENTS

Objective: To evaluate the efficacy, safety, and cost of preemptive ganciclovir therapy in cytomegalovirus (CMV)-seropositive renal transplant recipients treated with antilymphocyte antibody (ALA) preparations. Design and Setting: A prospective, randomized trial at a 650-bed tertiary medical center hospital. Patients: Forty consecutive CMV-seropositive renal allograft recipients who underwent transplantation between January 1992 and January 1994 and were treated with ALA for induction immunosuppression or acute rejection therapy. Main Outcome Measures: The incidence and severity of CMV disease, length of hospitalization, and patient and allograft survival. Intervention: Cytomegalovirus infection prophylaxis by use of intravenous ganciclovir during ALA. therapy was administered to 22 patients (group 1) and the results were compared with those obtained in 18 control patients who did not receive prophylaxis for CMV disease (group 2). Results: Preemptive ganciclovir therapy significantly reduced the incidence of CMV disease (P<.05) in CMV-seropositive renal transplant patients who were treated with AW and was well tolerated. In addition, the cost of prophylactic therapy was offset by the decreased length of hospitalization observed in patients in group 1. Conclusion: Preemptive ganciclovir therapy provides a cost-effective approach toward significantly improving the outcome of renal transplantation in CMV-seropositive patients treated with ALA.