Abstract:

Abstract:

Cytomegalovirus (CMV) is still a major pathogen in liver transplantation (LTX). The clinical efficacy of prophylactic high-dose acyclovir therapy (800 mg qid) was assessed for the prevention of CMV infection and disease in liver recipients. Fifty-five patients were enrolled in a prospective, randomised, double-blind and placebo-controlled trial; 28 on acyclovir vs. 27 on placebo. The therapy was given for 12 weeks. The patients were followed for 24 weeks.

CMV infection was diagnosed in 60% (16 on acyclovir, 17 on placebo) and CMV disease developed in 38% (7 on acyclovir, 14 on placebo) of the patients. The total mortality was 27% (6 on acyclovir, 10 on placebo). Acyclovir delayed 32% of the CMV infections and prevented 59% of the CMV disease cases which occurred in the placebo cohort. The time to CMV disease was significantly prolonged in patients on acyclovir as compared to patients on placebo (P=0.013).

Adverse events included neurotoxicity which occurred in 5 cases in the acyclovir, but none in the placebo arm, and nephrotoxicity which was detected in 6 patients in the acyclovir and 5 in the placebo arm, respectively.

We conclude that acyclovir prophylaxis significantly reduced the incidence of CMV disease, and delayed the onset of CMV infection in liver transplant patients.

Keywords: acyclovir; CMV prophylaxis; cytomegalovirus; transplantation; liver

Language: English

Document Type: Original article

DOI: 10.1034/j.1399-3062.1999.010202.x

Affiliations: 1: Division of Transplantation Surgery, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden, 2: Division of Clinical Immunology, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden, 3: Division of Clinical Virology, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden, 4: Division of Infectious Diseases, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden *