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Pre‐emptive intravenous ganciclovir versus valganciclovir prophylaxis for de novo cytomegalovirus‐seropositive kidney‐transplant recipients

This sequential study evaluated two strategies regarding human cytomegalovirus (HCMV) infection/disease in HCMV‐seropositive de novo kidney‐transplant patients. The first cohort of patients (group 1; n = 132) was monitored sequentially for HCMV DNAemia; if it was positive (a cut‐off at 3 log10copies/ml), the patient was given pre‐emptive IV ganciclovir therapy (10 mg/kg/day for 3 weeks). The second cohort consisted of 150 patients (group 2) who were given valganciclovir (VGC) prophylaxis (900 mg/day) for the first 3 months posttransplantation. During the mean follow‐up of at least 2 years for both cohorts, VGC prophylaxis resulted in a significant decrease in both CMV infection (68.9% vs. 33.3%; P < 0.001) and disease (9.8% vs. 2.68%, P = 0.021). Factors associated with HCMV reactivation in multivariate analysis were (i) no HCMV prophylaxis; (ii) recipient’s age; (iii) being placed on ciclosporine A and mycophenolic acid from the beginning of transplantation (iv) donor HCMV‐seropositivity; and (v) being a male recipient. No cases of ganciclovir resistance were detected in the prophylactic group. HCMV prophylaxis had no impact on 2‐year patient/graft survival or on kidney‐allograft function. We conclude that VGC‐prophylaxis can be reasonably used to treat HCMV‐seropositive kidney‐transplant recipients.