Multicenter evaluation of efficacy and safety of low-dose versus high-dose valganciclovir for prevention of cytomegalovirus disease in donor and recipient positive (D+/R+) renal transplant recipients

Transpl Infect Dis. 2016 Dec;18(6):904-912. doi: 10.1111/tid.12609. Epub 2016 Nov 7.


Background: The cytomegalovirus (CMV) donor-positive/recipient-positive (D+/R+) population is the largest proportion of renal transplant recipients (RTR). Guidelines for prevention of CMV in the intermediate-risk D+/R+ population include prophylaxis with valganciclovir (VGCV) 900 mg/day for 3 months. This study is the first head-to-head analysis, to our knowledge, comparing the efficacy and safety CMV prophylaxis of VGCV 450 vs 900 mg/day for 3 months in D+/R+ RTR.

Methods: A multicenter, retrospective analysis evaluated 478 adult RTR between January 2008 and October 2011. Study participants received VGCV 450 mg/day (Group 1; n=398) or 900 mg/day (Group 2; n=89)×3 months for CMV prophylaxis. All VGCV was adjusted for renal function. All groups included in this study received study-approved induction and maintenance immunosuppression regimens. The primary endpoint was incidence of CMV disease at 12 months.

Results: The rates of graft loss, patient survival, T-cell and/or antibody-mediated rejection, hematological adverse events, opportunistic infections, and early VGCV discontinuation were evaluated. Patient demographics were comparable, but had significant differences in ethnicity and donor type between the groups.

Conclusion: The occurrence of CMV disease at 12 months was similar between the groups (3.5% vs 3.4%; P=1.000). Log-rank test found no statistically significant difference in the time to development of CMV between the 2 groups (P=.939).

Keywords: antivirals; cytomegalovirus; prophylaxis; valganciclovir.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Adult
  • Allografts / virology
  • Antibiotic Prophylaxis / methods*
  • Antiviral Agents / administration & dosage
  • Antiviral Agents / adverse effects
  • Antiviral Agents / therapeutic use*
  • Cytomegalovirus / isolation & purification*
  • Cytomegalovirus Infections / blood
  • Cytomegalovirus Infections / epidemiology
  • Cytomegalovirus Infections / prevention & control*
  • Cytomegalovirus Infections / virology
  • Female
  • Follow-Up Studies
  • Ganciclovir / administration & dosage
  • Ganciclovir / adverse effects
  • Ganciclovir / analogs & derivatives*
  • Ganciclovir / therapeutic use
  • Graft Rejection / epidemiology
  • Graft Rejection / immunology
  • Humans
  • Immunosuppression Therapy / methods
  • Incidence
  • Kidney Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Opportunistic Infections / epidemiology
  • Practice Guidelines as Topic
  • Retrospective Studies
  • Serologic Tests
  • Transplant Recipients
  • Treatment Outcome
  • Valganciclovir


  • Antiviral Agents
  • Valganciclovir
  • Ganciclovir