Preemptive therapy for prevention and treatment of cytomegalovirus disease after renal transplantation

    TIAN Xiaoª²Hui, XUE Wuª²Jun, DING Xiaoª²Ming, YAN Hang, HE Xiaoª²Li

    Department of Renal Transplantation, First Hospital, Xi¬ðan Jiaotong University, Xi¬ðan 710061, China

    ¡¾Abstract¡¿ AIM: To evaluate the efficacy and costª²effectiveness of preemptive therapy guided by cytomegalovirus (CMV)ª²PP65 antigenemia and prophylactic therapy. METHODS: Eighty cases who had undergone renal transplantation were randomly divided into 2 groups: ¢Ù preª²emptive therapy group (n=40), who were given ganciclovir (GCV, 250 mg/d) once at least 1 CMVª²PP65 positive cell per 2.0¡Á105 PBL (peripheral blood leucocyte) till the antigenemia became negative. ¢Ú Control group (n=40), who were given universal twoª²weekª²prophylaxis with GCV (250 mg/d) beginning at the 3rd week after transplantation. A 3ª²month followª²up was conducted and the efficacy and costª²effectiveness of the 2 groups were compared. RESULTS: There was no statistical difference between preemptive therapy group and control group in the incidence of CMV disease, CMV active infection, relapse of CMV disease, CMVª²related mortality and sideª²effects of ganciclovir. But the course of treatment in the former was shorter than that in the latter [(8.5¡À3.2)d vs (14.0¡À0.0)d]. Twelve of the 15 highª²risk cases in the preemptive group received preemptive therapy, of whom 2 cases developed CMV disease but were cured. CONCLUSION: Preemptive therapy with ganciclovir, a more selective and shorter course of treatment, is as safe and effective as universal prophylaxis in preventing CMV disease and protecting highª²risk cases in renal transplant recipients. ......