{"id":1659,"date":"2018-09-13T12:57:41","date_gmt":"2018-09-13T12:57:41","guid":{"rendered":"http:\/\/edren.org\/ren\/?page_id=1659"},"modified":"2021-10-07T14:53:04","modified_gmt":"2021-10-07T14:53:04","slug":"cytomegalovirus-cmv","status":"publish","type":"page","link":"https:\/\/edren.org\/ren\/handbook\/transplant-handbook\/infection-prophylaxis-and-treatment\/cytomegalovirus-cmv\/","title":{"rendered":"Cytomegalovirus (CMV)"},"content":{"rendered":"<ul style=\"list-style-type: disc;\">\n<li>All transplant recipients except CMV IgG negative recipients of CMV IgG negative donors (D-\/R-) receive CMV prophylaxis with valganciclovir for 6 months.<\/li>\n<li>If T-Cell depleting induction [ATG\/Alemtuzumab (Campath)] is used, CMV D-\/R- cases will also receive 6 months valganciclovir.<\/li>\n<\/ul>\n<p><span style=\"font-family: georgia, palatino, serif;\">The initial valganciclovir dose is dependent on renal function as shown in the table below:<\/span><\/p>\n<table style=\"border-color: #993300; width: 85.76%; height: 120px;\" border=\"1\" cellspacing=\"1\" cellpadding=\"1\" align=\"center\">\n<tbody>\n<tr style=\"height: 24px;\">\n<td style=\"border-color: #993300; width: 50%; height: 24px; background-color: #e6f7ed;\"><strong><span style=\"color: #993300;\">Creatinine clearance (ml\/min)<\/span><\/strong><\/td>\n<td style=\"border-style: solid; border-color: #993300; width: 65.76%; height: 24px; background-color: #e6f7ed;\"><strong><span style=\"color: #993300;\">Prophylactic dose of valganciclovir<\/span><\/strong><\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"border-color: #993300; width: 50%; height: 24px;\">&gt;40<\/td>\n<td style=\"border-style: solid; border-color: #993300; width: 65.76%; height: 24px;\">450mg od<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"border-color: #993300; width: 50%; height: 24px;\">25 to 39<\/td>\n<td style=\"border-style: solid; border-color: #993300; width: 65.76%; height: 24px;\">450mg every 2 days<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"border-color: #993300; width: 50%; height: 24px;\">10 to 24<\/td>\n<td style=\"border-style: solid; border-color: #993300; width: 65.76%; height: 24px;\">450mg twice weekly<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<ul style=\"list-style-type: disc;\">\n<li>Note that our maximum dose of valganciclovir is 450mg od (even if creatinine clearance &gt;60 ml\/min).<\/li>\n<li>Valganciclovir is available as 450mg tablets. The tablets should be taken with food and not broken or crushed.<\/li>\n<li>FBC and LFTs must be monitored during therapy.<\/li>\n<\/ul>\n<h3><span style=\"color: #993300;\"><strong><span style=\"color: #993300;\">Investigation of any episode of illness that might be CMV related, at any stage following a transplant operation.<\/span><\/strong><\/span><\/h3>\n<ul style=\"list-style-type: disc;\">\n<li>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.).<\/li>\n<li>Request CMV PCR.<\/li>\n<li>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).<\/li>\n<li>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.<\/li>\n<\/ul>\n<h3><strong><span style=\"color: #993300;\">Treatment of CMV disease<\/span><\/strong><\/h3>\n<ul style=\"list-style-type: disc;\">\n<li>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.<\/li>\n<li>Ideally, this should be continued until two consecutive (within the same week) negative CMV PCR results have been obtained.<\/li>\n<li>Dose of IV gancyclovir will depend on creatinine clearance:<\/li>\n<\/ul>\n<table style=\"border-style: solid; width: 89.48%; height: 144px;\" border=\"2\" cellspacing=\"2\" cellpadding=\"2\" align=\"center\">\n<tbody>\n<tr style=\"height: 24px;\">\n<td style=\"border-style: solid; border-color: #993300; width: 46.83%; height: 24px; background-color: #e6f7ed;\"><strong><span style=\"color: #993300;\">Creatinine clearance (ml\/min)<\/span><\/strong><\/td>\n<td style=\"border-style: solid; border-color: #993300; width: 62.5%; height: 24px; background-color: #e6f7ed;\"><strong><span style=\"color: #993300; font-family: georgia, palatino, serif;\">Treatment dose of ganciclovir IV<\/span><\/strong><\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"border-style: solid; border-color: #993300; width: 46.83%; height: 24px;\">&gt;70<\/td>\n<td style=\"border-style: solid; border-color: #993300; width: 62.5%; height: 24px;\">5mg\/kg every 12 hours<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"border-style: solid; border-color: #993300; width: 46.83%; height: 24px;\">50 to 69<\/td>\n<td style=\"border-style: solid; border-color: #993300; width: 62.5%; height: 24px;\">2.5mg\/kg every 12 hours<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"border-style: solid; border-color: #993300; width: 46.83%; height: 24px;\">25 to 49<\/td>\n<td style=\"border-style: solid; border-color: #993300; width: 62.5%; height: 24px;\">2.5mg\/kg\/day<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"border-style: solid; border-color: #993300; width: 46.83%; height: 24px;\">10 to 24<\/td>\n<td style=\"border-style: solid; border-color: #993300; width: 62.5%; height: 24px;\">1.25mg\/kg\/day<\/td>\n<\/tr>\n<tr style=\"height: 24px;\">\n<td style=\"border-style: solid; border-color: #993300; width: 46.83%; height: 24px;\">&lt;10<\/td>\n<td style=\"border-style: solid; border-color: #993300; width: 62.5%; height: 24px;\">1.25mg\/kg\/day after haemodialysis<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<ul style=\"list-style-type: disc;\">\n<li>Ganciclovir is made in the aseptic department in pharmacy, contact the renal transplant pharmacist to organize a supply.<\/li>\n<\/ul>\n<p><span lang=\"EN-US\">In some cases (asymptomatic or mild disease, low viral loads) treatment with oral valganciclovir can be used instead of IV ganciclovir. The doses are:\u00a0<\/span><\/p>\n<table style=\"width: 90%; border-color: #993300; border-style: solid;\" border=\"2\" cellspacing=\"2\" cellpadding=\"2\" align=\"center\">\n<tbody>\n<tr>\n<td style=\"border-style: solid; border-color: #993300; width: 50%; background-color: #e6f7ed;\"><strong><span style=\"color: #993300;\">Creatinine clearance (ml\/min)<\/span><\/strong><\/td>\n<td style=\"border-style: solid; border-color: #993300; width: 62.06%; background-color: #e6f7ed;\"><strong><span style=\"color: #993300;\">Treatment dose of Valganciclovir tablets<\/span><\/strong><\/td>\n<\/tr>\n<tr>\n<td style=\"width: 50%; border-color: #993300; border-style: solid;\">&gt;60<\/td>\n<td style=\"width: 62.069%; border-color: #993300; border-style: solid;\">900mg (2 tablets) twice daily<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 50%; border-color: #993300; border-style: solid;\">40 to 59<\/td>\n<td style=\"width: 62.069%; border-color: #993300; border-style: solid;\">450mg (1 tablet) twice daily<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 50%; border-color: #993300; border-style: solid;\">25 to 39<\/td>\n<td style=\"width: 62.069%; border-color: #993300; border-style: solid;\">450mg daily<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 50%; border-color: #993300; border-style: solid;\">10 to 24<\/td>\n<td style=\"width: 62.069%; border-color: #993300; border-style: solid;\">450mg every 2 days<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 50%; border-color: #993300; border-style: solid;\">&lt;10<\/td>\n<td style=\"width: 62.069%; border-color: #993300; border-style: solid;\">Not recommended<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n","protected":false},"excerpt":{"rendered":"<p>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\u2026<\/p>\n<p> <a class=\"continue-reading-link\" href=\"https:\/\/edren.org\/ren\/handbook\/transplant-handbook\/infection-prophylaxis-and-treatment\/cytomegalovirus-cmv\/\"><span>Continue reading<\/span><i class=\"crycon-right-dir\"><\/i><\/a> <\/p>\n","protected":false},"author":2,"featured_media":0,"parent":1628,"menu_order":148,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"no","_lmt_disable":"","footnotes":""},"class_list":["post-1659","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/1659","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/comments?post=1659"}],"version-history":[{"count":12,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/1659\/revisions"}],"predecessor-version":[{"id":5623,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/1659\/revisions\/5623"}],"up":[{"embeddable":true,"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/pages\/1628"}],"wp:attachment":[{"href":"https:\/\/edren.org\/ren\/wp-json\/wp\/v2\/media?parent=1659"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}