Key result
Low-dose valacyclovir prophylaxis (3 g/day) for 90 days post-transplantation resulted in comparable 5-year survival to CTS data, with a 25% incidence of CMV disease and 2% neurotoxicity.
Why the study?
Does low-dose valacyclovir prophylaxis improve patient and graft survival and reduce CMV disease in high-risk CMV-seromismatched renal transplant patients?
Cohort (n=102)
Does low-dose valacyclovir prophylaxis improve patient and graft survival and reduce CMV disease in high-risk CMV-seromismatched renal transplant patients?
Low-dose valacyclovir (3 g/day) for 90 days post-transplantation in high-risk renal transplant patients yields comparable survival to historical controls with minimal neurotoxicity.
Answers are grounded in this paper and cite their sources.
Supports low-dose valacyclovir tolerability in renal transplant recipients; leaves open CMV prevention efficacy in seromismatched cases.
BACKGROUND: Cytomegalovirus (CMV) remains an important pathogen in transplant patients, and valacyclovir (VACV) prophylaxis 8 g/day has been used in high-risk CMV-seromismatched [D+/R-] renal transplant patients to decrease CMV disease. Neurotoxic adverse effects have limited its use, and the aim of the present study was to retrospectively evaluate low-dose VACV prophylaxis, 3 g/day for 90 days after transplantation, in 102 D+/R- renal transplant patients. METHODS: We compared patient and graft survival rates up to 5 years after transplantation with the data from the Collaborative Transplant Study Group (CTS) database. The incidence of CMV disease, rejection and neurotoxic adverse effects was analyzed up to 1 year after transplantation. RESULTS: The patient and graft survival rates up to 5 years were comparable with those derived from the CTS. CMV disease was diagnosed in 25% of the patients and 2% developed tissue-invasive CMV disease. The rejection frequency was 22% and neurotoxic adverse effects were seen in 2% of the patients. CONCLUSIONS: Low-dose VACV prophylaxis (3 g/day) for 90 days post-transplantation results in high patient and graft survival rates and reduces the incidence of CMV disease. Neurotoxic adverse effects are minimal. We believe that low-dose VACV prophylaxis should be considered to form one of the arms in future prospective comparison studies for the prevention of CMV disease in the high-risk D+/R- population of renal transplant patients.
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Sund et al. (2012) conducted a cohort in high-risk CMV-seromismatched [D+/R-] renal transplant (n=102). Low-dose valacyclovir vs. Collaborative Transplant Study Group (CTS) database was evaluated on Patient and graft survival rates up to 5 years and incidence of CMV disease. Low-dose valacyclovir prophylaxis (3 g/day) for 90 days post-transplantation resulted in comparable 5-year survival to CTS data, with a 25% incidence of CMV disease and 2% neurotoxicity.
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