Cytomegalovirus (CMV)

  • All transplant recipients except CMV IgG negative recipients of CMV IgG negative donors (D-/R-) receive CMV prophylaxis with valganciclovir for 6 months.
  • If T-Cell depleting induction [ATG/Alemtuzumab (Campath)] is used, CMV D-/R- cases will also receive 6 months valganciclovir.

The initial valganciclovir dose is dependent on renal function as shown in the table below:

Creatinine clearance (ml/min) Prophylactic dose of valganciclovir
>40 450mg od
25 to 39 450mg every 2 days
10 to 24 450mg twice weekly
  • Note that our maximum dose of valganciclovir is 450mg od (even if creatinine clearance >60 ml/min).
  • Valganciclovir is available as 450mg tablets. 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.

In some cases (asymptomatic or mild disease, low viral loads) treatment with oral valganciclovir can be used instead of IV ganciclovir. The doses are: 

Creatinine clearance (ml/min) Treatment dose of Valganciclovir tablets
>60 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
<10 Not recommended