Outcome of low-dose ganciclovir for cytomegalovirus disease prophylaxis in renal-transplant recipients

To assess the outcome of low-dose-ganciclovir prophylaxis (500 mg twice a day for 3 months) in renal-transplant recipients, a retrospective analysis of 185 patients transplanted between 1998 and 2001 was performed. There were 29 (15.6%) patients who belonged to the highest risk group, donor cytomegalovirus (CMV) positive, recipient negative (D+R-), and 37 (20%) patients in the lowest risk group, D-R-. Induction immunosuppression consisted of polyclonal antibody or OKT3 (n=62, 33.5%), interleukin-2 receptor antibody (n=61, 33%), and no induction (n=62, 33.5%). CMV disease occurred in 13 (7%) patients. Highest incidence was in D+R- group (17.2%), with no cases in D-R- group (P=0.03). Tissue-invasive CMV occurred in 4 of these 13 patients. In patients developing CMV disease, there was no evidence of ganciclovir resistance and no mortality over a mean follow-up of 42 months. Low-dose ganciclovir was found to be as effective in decreasing the incidence of clinical CMV disease as high-dose ganciclovir (I gm three times a day for 3-6 months) in previous studies.