High-dose acyclovir prophylaxis reduces cytomegalovirus disease in liver transplant patients
Article first published online: 5 JAN 2002
Transplant Infectious Disease
Volume 1, Issue 2, pages 89–97, June 1999
How to Cite
Barkholt, L., Lewensohn-Fuchs, I., Ericzon, B.-G., Tydén, G. and Andersson, J. (1999), High-dose acyclovir prophylaxis reduces cytomegalovirus disease in liver transplant patients. Transplant Infectious Disease, 1: 89–97. doi: 10.1034/j.1399-3062.1999.010202.x
- Issue published online: 5 JAN 2002
- Article first published online: 5 JAN 2002
- Received 2 November, revised, accepted for publication 9 December 1998
- CMV prophylaxis;
Cytomegalovirus (CMV) is still a major pathogen in liver transplantation (LTX). The clinical efficacy of prophylactic high-dose acyclovir therapy (800 mg qid) was assessed for the prevention of CMV infection and disease in liver recipients. Fifty-five patients were enrolled in a prospective, randomised, double-blind and placebo-controlled trial; 28 on acyclovir vs. 27 on placebo. The therapy was given for 12 weeks. The patients were followed for 24 weeks.
CMV infection was diagnosed in 60% (16 on acyclovir, 17 on placebo) and CMV disease developed in 38% (7 on acyclovir, 14 on placebo) of the patients. The total mortality was 27% (6 on acyclovir, 10 on placebo). Acyclovir delayed 32% of the CMV infections and prevented 59% of the CMV disease cases which occurred in the placebo cohort. The time to CMV disease was significantly prolonged in patients on acyclovir as compared to patients on placebo (P=0.013).
Adverse events included neurotoxicity which occurred in 5 cases in the acyclovir, but none in the placebo arm, and nephrotoxicity which was detected in 6 patients in the acyclovir and 5 in the placebo arm, respectively.
We conclude that acyclovir prophylaxis significantly reduced the incidence of CMV disease, and delayed the onset of CMV infection in liver transplant patients.