GANCICLOVIR PROPHYLAXIS IS MORE EFFECTIVE THAN INTRAVENOUS IMMUNOGLOBULIN(IVIG) IN PREVENTING CYTOMEGALOVIRUS (CMV) DISEASE IN RENAL TRANSPLANT RECIPIENTS

Abstract

605 CMV disease is the most important infectious complication in renal transplantation that is associated with increased morbidity and mortality. We compared the effectiveness of two different prophylactic protocols(Ganciclovir vs IVIG) against CMV disease in renal transplant recipients. Sixty-nine renal transplant recipients at risk of developing CMV disease were identified retrospectively. These were CMV- recipients of CMV + donor kidneys (R-D+) and CMV + recipients of either CMV + (R+D+) or CMV-(R+D-) donor kidneys who received immunosuppression with antilymphocyte globulin. Patients received either IVIG(n=42) or Ganciclovir (n=30) prophylaxis. IVIG (GAMMAR, ARMOUR, Kankakee, IL) dose was 500mg/kg at weeks 1, 2, and 4 post transplant, then 250mg/kg wks 6 and 8. Ganciclovir was given during hospital stay and in conjunction with antilymphocyte therapy at a dose of 2.5mg/kg every 1-3 days depending on serum creatinine. All patients received Acyclovir 600-3200 mg/day depending on weight and serum creatinine for 12 weeks post transplant. CMV disease was defined as CMV + buffy coat plus any 2 combinations: Leukopenia<3000 mm3, fever > 38 °C for > 3 days, increased liver function tests, tissue involvement on biopsy (renal, bronchial, etc.) Incidence of CMV disease was as follows: TableThese data demonstrate that Ganciclovir is more effective than IVIG in the prevention of CMV disease in high risk renal transplant patients (R-D+).