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Keywords:

  • CMV immunoglobulin;
  • cytomegalovirus disease;
  • kidney transplantation;
  • prophylaxis;
  • valaciclovir

ABSTRACT

Background:  Cytomegalovirus (CMV) remains an important cause of disease in renal transplant recipients. Prophylaxis is effective in reducing disease; however, the optimal regimen remains uncertain. We assessed the efficacy of low-dose valaciclovir (3 months) and intravenous CMV immunoglobulin in the prevention of CMV disease in CMV-negative recipients of kidneys from CMV-positive donors (D+/R−).

Methods:  A single-centre, retrospective study examining the incidence of CMV disease and patient and graft survival in all patients transplanted between October 2000 and November 2004.

Results:  Among 203 renal transplant recipients, 46 were D+/R− (22.7%) and received prophylaxis. Of the 203 recipients, 21 (10.3%) developed CMV disease over a four-year follow-up period. Within the D+/R− group, CMV disease occurred in 15.2% of patients at 6 months (7/46), and 21.7% at 4 years (10/46). Of the 10 D+/R− patients who developed CMV disease, six were inadvertently on a dose of valaciclovir below that dictated by protocol arising from a failure to increase dosage in parallel with improving recipient renal function. In the D+/R− recipients where the protocol was adhered to, the incidence of CMV disease was 5% (2/40) at 6 months, and 10% (4/40) at 4 years.

Conclusion:  Low-dose valaciclovir with CMV immunoglobulin was as efficacious in preventing CMV disease as other published regimens, including those with full-dose valaciclovir and valganciclovir. There was a low incidence of CMV disease beyond 6 months. Outcomes could be improved by ensuring appropriate dose adjustment following changes in renal function.