CMV INFECTION / PROPHYLAXIS
- All transplant recipients except CMVâ€“ve recipients of CMVâ€“ve donors receive CMV prophylaxis with valganciclovir.
- If T-Cell depleting induction [ATG/Alemtuzumab (Campath)] is used, CMV D-/R- cases will also receive 6 months valganciclovir.
- Therapy will be continued in primary care for up to a total of 180 days treatment.
The initial valganciclovir dose is dependent on renal function as shown in the table below:
|Creatinine clearance (ml/min)||Prophylactic dose of valganciclovir|
|40 to 59||450mg od|
|25 to 39||450mg every 2 days|
|10 to 24||450mg twice weekly|
- Valganciclovir is available as 450mg tablets (pink) and the brand name is ValcyteÃ¢. The tablets should be taken with food and not broken or crushed.
- FBC and LFTs must be monitored during therapy.
Investigation of any episode of illness that might be CMV related, at any stage following a transplant operation.
- An EDTA (4.5ml) sample for CMV should be sent to Virology whenever is clinically relevant; on request form, include details of illness (e.g. pyrexia or hepatitis etc.).
- Request CMV PCR.
- Please try to ensure samples reach General Laboratory Reception (FAO Virology), Level 2, RIE, by 9am weekdays; the assay is carried out at least twice weekly (Tuesdays, Fridays).
- It will often be appropriate to send respiratory and/or other samples (e.g. broncho-alveolar lavage, induced sputum or fresh colon biopsies) for CMV PCR testing.
Treatment of CMV disease
- Patients in whom the diagnosis of CMV disease has been made with positive CMV PCR should be treated with IV ganciclovir followed by oral valganciclovir; whilst the approach should be decided on a case-by-case basis as per severity of disease and/or viral load, a general initial approach should aim for 2 weeks IV ganciclovir followed by oral valganciclovir.
- Ideally, this should be continued until two consecutive (within the same week) negative CMV PCR results have been obtained.
- Dose of IV gancyclovir will depend on creatinine clearance:
|Creatinine clearance (ml/min)||Treatment dose of ganciclovir IV|
|>70||5mg/kg every 12 hours|
|50 to 69||2.5mg/kg every 12 hours|
|25 to 49||2.5mg/kg/day|
|10 to 24||1.25mg/kg/day|
|<10||1.25mg/kg/day after haemodialysis|
- Ganciclovir is made in the aseptic department in pharmacy, contact the renal transplant pharmacist to organize a supply.
If indicated treatment doses of Valganciclovir can be used as shown in table below:
|Creatinine clearance (ml/min)||Treatment dose of Valganciclovir tablets|
900mg (2 tablets) twice daily
|40 to 59||450mg (1 tablet) twice daily|
|25 to 39||450mg daily|
|10 to 24||450mg every 2 days|