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lüll Similar reduction of cytomegalovirus DNA load by oral valganciclovir and intravenous ganciclovir on pre-emptive therapy after renal and renal-pancreas transplantation Kalpoe JS; Schippers EF; Eling Y; Sijpkens YW; de Fijter JW; Kroes ACAntivir Ther 2005[]; 10 (1): 119-23BACKGROUND: Pre-emptive treatment of CMV infection in transplant recipients aims at prevention of clinical disease by early detection. However, current treatment requires the intravenous (iv) administration of ganciclovir for 2 weeks, which is a considerable burden for the patient. In this observational study, the efficacy of the new oral prodrug valganciclovir was compared with iv ganciclovir. METHODS: To facilitate the introduction of valganciclovir, a therapeutic guideline was developed to use this drug under controlled conditions with regard to safety in renal/renal-pancreas transplant recipients requiring CMV therapy. Subsequently, a group of 57 consecutive transplant recipients was evaluated. Onset and treatment of CMV infections were followed by frequent monitoring of CMV DNA in plasma by quantitative real-time PCR. Details of antiviral therapy were documented. RESULTS: In 15 out of 57 transplant recipients, a total of 27 anti-CMV treatment episodes were recorded: 18 with valganciclovir (900 mg twice daily) and nine with iv ganciclovir (5 mg/kg twice daily) as initial treatment. Median CMV DNA load reduction during treatment was 0.12 log10/day in the valganciclovir group and 0.09 log10/day in the ganciclovir group. There were no haematological side effects in any group and no patient developed signs of clinical CMV disease. CONCLUSION: Similar reduction of CMV DNA load was observed during pre-emptive treatment with oral valganciclovir and iv ganciclovir in transplant recipients. Oral valganciclovir would provide an attractive and safe alternative for pre-emptive CMV treatment in renal/renal-pancreas transplant patients, however, confirmation in larger randomized studies would be desirable.|*Kidney Transplantation/adverse effects[MESH]|*Pancreas Transplantation/adverse effects[MESH]|Administration, Oral[MESH]|Adult[MESH]|Aged[MESH]|Antiviral Agents/*administration & dosage[MESH]|Cytomegalovirus Infections/drug therapy/*prevention & control/virology[MESH]|Cytomegalovirus/*drug effects/genetics[MESH]|DNA, Viral/*blood/genetics[MESH]|Female[MESH]|Ganciclovir/*administration & dosage/*analogs & derivatives[MESH]|Humans[MESH]|Injections, Intravenous[MESH]|Male[MESH]|Middle Aged[MESH]|Opportunistic Infections/drug therapy/prevention & control/virology[MESH]|Safety[MESH]|Valganciclovir[MESH] |