Valganciclovir for the prophylaxis and treatment of cytomegalovirus infection in solid organ transplantation

Cytomegalovirus (CMV) can be a problematic virus for solid organ transplant recipients affecting both morbidity and mortality. Valganciclovir (VGC) is a commonly utilized antiviral agent for the prevention of this virus post-transplantation and recently it has been evaluated for the treatment of CMV. It is a pro-drug of ganciclovir (GCV) and has increased bioavailability compared to GCV. It is unclear whether VGC is superior to intravenous or oral GCV in terms of efficacy and safety in the prevention of CMV particularly in the liver transplant population as there have been studies reporting inferiority while other studies have not. Despite this, VGC has been reported to be the most commonly utilized agent for CMV prophylaxis in the liver transplant population in the United States and Canada. This article reviews CMV and VGC in the context of solid organ transplant, describes and assesses selected studies that have been conducted using this agent in this patient population, and summarizes VGC's advantages and disadvantages. Additional studies are needed to further define VGC's role in the treatment of CMV in the solid organ transplantation population as there are an insufficient number of studies pertaining to CMV treatment and no studies have been performed to assess its role in the treatment of life-threatening CMV disease. VGC is non-inferior to GCV for CMV prevention in the solid organ transplant population with the exception of liver transplant recipients.