Antiviral medications for preventing cytomegalovirus disease in solid organ transplant recipients

Children's Hospital at Westmead, Centre for Kidney Research, Locked Bag 4001, Westmead, NSW, Australia, 2145.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2008; 2(2):CD003774. DOI: 10.1002/14651858.CD003774.pub3
Source: PubMed


Cytomegalovirus (CMV; a herpes virus) is the most common type of virus detected in people who have received solid organ transplants (kidney, heart, liver, lung and pancreas). CMV disease is a major cause of illness and death during the first six to 12 months after transplantation. Two main strategies to prevent CMV disease have been adopted: protection and prevention (prophylaxis) of viral infections for all organ recipients using antiviral drugs, or 'pre-emptive therapy' of organ recipients, who develop evidence of CMV infection during routine screening. We looked at the benefits and harms of antiviral prophylaxis to prevent CMV disease in people who are solid organ transplant recipients. The evidence we found shows that some antiviral drugs (ganciclovir, valaciclovir and aciclovir) reduced the risk of CMV disease, death due to CMV disease, clinical disease caused by herpes simplex and herpes zoster viruses, bacterial infections and protozoal infections. For CMV disease and death, the relative benefits of aciclovir, ganciclovir and valaciclovir appear consistent across recipients of heart, kidney and liver transplants. These benefits occur in both CMV positive transplant recipients and CMV negative transplant recipients of CMV positive donor organs, with or without the inclusion of antilymphocyte antibody therapy, and the benefits were seen at all measured time points. We found that ganciclovir is more effective than aciclovir and as effective as valganciclovir, which is currently the most commonly used antiviral drug to prevent CMV disease in transplant recipients. Extended duration of prophylaxis was found to be more effective than three months of therapy in kidney and lung transplant recipients. More studies are needed to determine the optimum duration and dosage of antiviral drugs for all solid organ transplant recipients.

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    • "Based on current data, the optimal preemptive strategy is unknown. Preemptive therapy is well suited for transplant recipients at low or intermediate risk of CMV disease, while prophylaxis may be better suited for those at high risk [44] [45]. Some studies have concluded that preemptive valganciclovir therapy and valacyclovir prophylaxis are equally effective in the prevention of CMV disease after renal transplantation and there was no difference in overall costs [46] [47]. "
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    ABSTRACT: Viruses are among the most common causes of opportunistic infection after transplantation. The risk for viral infection is a function of the specific virus encountered, the intensity of immune suppression used to prevent graft rejection, and other host factors governing susceptibility. Although cytomegalovirus is the most common opportunistic pathogen seen in transplant recipients, numerous other viruses have also affected outcomes. In some cases, preventive measures such as pretransplant screening, prophylactic antiviral therapy, or posttransplant viral monitoring may limit the impact of these infections. Recent advances in laboratory monitoring and antiviral therapy have improved outcomes. Studies of viral latency, reactivation, and the cellular effects of viral infection will provide clues for future strategies in prevention and treatment of viral infections. This paper will summarize the major viral infections seen following transplant and discuss strategies for prevention and management of these potential pathogens.
    The Scientific World Journal 05/2012; 2012:820621. DOI:10.1100/2012/820621 · 1.73 Impact Factor
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    • "Acyclovir has less activity against CMV and is not recommended specifically for prophylaxis. The efficacy of prophylaxis with either CMV immune globulin (CMVIG) or intravenous immune globulin (IVIG) in kidney organ transplant recipients has been investigated in relatively few trials (Hodson et al., 2007), the majority of which have been randomized, but not blinded. Further research is needed to delineate the benefit of adding immune globulin to current CMV prophylaxis regimens. "
    After the Kidney Transplant - The Patients and Their Allograft, 08/2011; , ISBN: 978-953-307-807-6
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    • "A recent Cochrane database systematic review confirmed this by examining 34 studies with 3,850 participants. This meta-analysis study concluded that prophylaxis with antiviral medications reduces CMV disease and CMV-related mortality in solid organ transplants [22]. Prophylaxis with acyclovir, ganciclovir or valacylcovir has also been reported to reduce the risks of diseases associated with herpes simplex, herpes zoster, bacterial and protozoal infections [23]. "
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    ABSTRACT: Death with a functioning kidney graft (DWFG) is now a major cause of graft loss after renal transplantation, occurring in up to 40% of cases. Its occurrence provides insight into the medical care of subjects with a functioning kidney transplant. In this study, we used the time to DWFG as an endpoint, to test whether improved medical care has contributed to better kidney transplant outcomes. We used single-center data from the Milwaukee Regional Medical Center and Froedtert Hospital, on kidney-only transplants from 1969 through 2005. A total of 3,157 kidney transplants were done at our center during this time. There were 714 deaths with functioning kidney. We also recorded the major causes of DWFG over the time period from 1969 through 2005 divided into 3 epochs. The data were analyzed as a serial collection of yearly obituaries. The time to DWFG has increased to 10 years despite a 20-year increase in the mean age of transplant recipients over the same time period. Better pre-transplant evaluation, improved treatments for hypertension and hyperlipidemia, improved management of acute myocardial infarction, superior immunosuppressive protocols and better prophylaxis and treatment of infectious diseases have all likely contributed to this trend.
    International Urology and Nephrology 12/2010; 42(4):929-34. DOI:10.1007/s11255-010-9721-z · 1.52 Impact Factor
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