Long-term outcomes of CMV disease treatment with valganciclovir versus IV ganciclovir in solid organ transplant recipients

Am J Transplant. 2009 May;9(5):1205-13. doi: 10.1111/j.1600-6143.2009.02617.x.

Abstract

Though an important cause of morbidity and mortality in solid organ transplantation (SOT), the long-term outcomes of cytomegalovirus (CMV) disease treatment have not been well studied. In a randomized trial, 321 SOT recipients with CMV disease were followed 1 year after treatment with either twice daily intravenous ganciclovir or oral valganciclovir (for 21 days) followed by once daily valganciclovir until day 49 in all patients. Clinical and viral eradication of CMV disease was similar between groups. Clinical recurrence beyond day 49 was found in 15.1% and virological recurrence in 30.0%, no difference between groups (p > 0.77). In a multivariable logistic regression analysis, the only independent predictor for recurrence was failure to eradicate DNAemia by day 21 (clinical: OR 3.9 [1.3-11.3], p = 0.012; virological: OR 5.6 [2.5-12.6], p < 0.0001). Eight patients developed ganciclovir resistance, with no difference between groups (p = 0.62). Twenty patients (valganciclovir: 11, ganciclovir: 9, p = 0.82) died, 12 due to infections, two involving CMV disease. There were no differences in long-term outcomes between treatment arms, further supporting the use of oral valganciclovir for treatment of CMV disease. Persistent DNAemia at day 21, CMV IgG serostatus and development of resistance may be relevant factors for further individualization of treatment.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antibodies, Viral / blood
  • Antiviral Agents / therapeutic use
  • Cytomegalovirus / immunology
  • Cytomegalovirus Infections / complications*
  • Cytomegalovirus Infections / drug therapy*
  • Drug Resistance / drug effects
  • Drug Resistance / physiology
  • Ethnic Groups
  • Female
  • Ganciclovir / administration & dosage
  • Ganciclovir / analogs & derivatives*
  • Ganciclovir / therapeutic use*
  • Humans
  • Immunoglobulin G / blood
  • Injections, Intravenous
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Organ Transplantation / adverse effects*
  • Regression Analysis
  • Treatment Outcome
  • Valganciclovir
  • Viral Load
  • Viremia / drug therapy

Substances

  • Antibodies, Viral
  • Antiviral Agents
  • Immunoglobulin G
  • Valganciclovir
  • Ganciclovir