CMV in Transplant Recipients: Is 6 Months of Prophylaxis Enough?

Ron Shapiro, MD


November 01, 2010

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Hi. My name is Ron Shapiro, and I'm a transplant surgeon at the University of Pittsburgh. Today I want to talk to you about prophylaxis of CMV [cytomegalovirus]. As you know, the availability of ganciclovir and, later on, valganciclovir has been very important in preventing the development of CMV disease, particularly in the high-risk population of CMV-seropositive donor and CMV-seronegative recipient. A study out of Helsinki[1] recently looked at their experience with 127 CMV-positive to -negative patients, and all of them had received 6 months of oral valganciclovir at 900 mg/day. They discovered, rather surprisingly, that there was a substantial incidence of CMV disease (34%) with an incidence of infection of 37% after discontinuation of the 6 months of prophylaxis. A detailed analysis failed to find any particular risk factors. They went on to discuss the implications of their study, and, of course, one of the potential implications is that 6 months may not be long enough. It may be necessary to provide prophylaxis for 9 months or even a year after transplantation. It is worth looking at this study, though, to realize that in the high-risk population it will be important to monitor patients after discontinuation of CMV prophylaxis to make sure that we are not missing CMV disease in our patients. Thank you.


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