Valacyclovir for cytomegalovirus prophylaxis reduces the risk of acute renal allograft rejection
Language English Country United States Media print
Document type Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't
PubMed
15699762
DOI
10.1097/01.tp.0000150024.01672.ca
PII: 00007890-200502150-00009
Knihovny.cz E-resources
- MeSH
- Acyclovir adverse effects analogs & derivatives therapeutic use MeSH
- Survival Analysis MeSH
- Antiviral Agents therapeutic use MeSH
- Time Factors MeSH
- Cytomegalovirus Infections prevention & control MeSH
- Adult MeSH
- Ganciclovir adverse effects therapeutic use MeSH
- Transplantation, Homologous MeSH
- Immunosuppressive Agents therapeutic use MeSH
- Middle Aged MeSH
- Humans MeSH
- Kidney Diseases classification surgery MeSH
- Graft Rejection epidemiology prevention & control MeSH
- Reoperation MeSH
- Risk Factors MeSH
- Histocompatibility Testing MeSH
- Kidney Transplantation mortality physiology MeSH
- Valacyclovir MeSH
- Valine adverse effects analogs & derivatives therapeutic use MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Clinical Trial MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
- Comparative Study MeSH
- Names of Substances
- Acyclovir MeSH
- Antiviral Agents MeSH
- Ganciclovir MeSH
- Immunosuppressive Agents MeSH
- Valacyclovir MeSH
- Valine MeSH
BACKGROUND: Both oral ganciclovir and valacyclovir decrease the incidence of cytomegalovirus (CMV) disease after renal transplantation. Moreover, valacyclovir has been shown to reduce the risk of acute rejection. Our study was designed to compare the efficacy and safety of oral ganciclovir and valacyclovir in the prophylaxis of CMV disease after renal transplantation. METHODS: A total of 83 patients were prospectively randomized to 3-month treatment with oral ganciclovir (3 g/day, n=36, GAN) or oral valacyclovir (8 g/day, n=35, VAL). A control group (DEF, n=12) was managed by deferred therapy. RESULTS: No differences were found in demography, immunosuppression, or donor/recipient CMV serology. The 12-month incidence of CMV disease was 67% in the DEF group compared with 6% in the GAN group and 3% in the VAL group (P<0.001 GAN or VAL vs. DEF; P=0.575 GAN vs. VAL). The biopsy-confirmed acute rejection rate at 12 months was 12% in the VAL group compared with 34% in the GAN group (P=0.030) and 58% in the DEF group (P<0.001). The difference between the GAN and DEF groups was not significant (P=0.087). The average CMV-associated costs per patient were $3,072, $2,906, and $4,906 in the GAN, VAL, and DEF groups, respectively. CONCLUSIONS: Valacyclovir and oral ganciclovir are equally effective in the prevention of CMV disease after renal transplantation. Both regimens are cost-effective. Valacyclovir is associated with a significantly reduced risk of acute rejection compared with both ganciclovir prophylaxis and deferred therapy.
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