The risk of disease is, of course, entirely dependent on the risk of CMV active infection, and viraemia in particular has a high positive predictive value for subsequent disease.
Lancet i—7. Pre-emptive therapy Pre-emptive therapy requires at least weekly screening for CMV infection for at least days post-transplant. Log in using your username and password For personal accounts OR managers of institutional accounts.
In addition, interferons and immunoglobulin preparations have been utilized. Ganciclovir pre-emptive therapy based on the CMV viraemia assay should be considered where rapid techniques are locally available Category 2. He had no other risk factors for developing acute kidney injury and was not volume depleted on examination. In both groups, therapy was continued until clinical signs disappeared and PCR negativity was documented. This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
There was no evidence of drug-related toxicity during the study. Immunodeficiency is moderate after autologous BMT since there is no need for immunosuppressive therapy.
Bone marrow transplantation—general aspects
No antiviral prophylaxis specifically directed at VZV infection is recommended Category 3. Thus, after an initial leucopenia, newly derived neutrophils, as well as platelets and erythrocytes, are able to carry out their most important respective functions.
Importantly, these findings have subsequently been reproduced using oral ganciclovir, also in liver transplant recipients, in a placebo-controlled study. The safety of prolonged iv access for immunosuppressed patients should be confirmed. Abstract The efficacy of oral acyclovir to prevent reactivation of herpes simplex virus HSV in seropositive renal allograft recipients was tested in a double-blind placebo controlled study. Receive exclusive offers and updates from Oxford Academic.
Generate a file for use with external citation management software. Prophylaxis Most of the studies on prevention have been in heart transplant recipients, with fewer in lung transplant recipients. Alternative strategies include short-term iv administration of ganciclovir, either during the first 2 weeks post-transplant with subsequent prolonged administration of high-dose oral acyclovir 60616368 or during post-transplant weeks 3 and 4 without subsequent acyclovir.
For instance, many units no longer use anti-lymphocyte preparations for the treatment or prophylaxis of graft rejection. Add to My Bibliography.
Treatment Following early reports of its effectiveness on CMV disease in immunocompromised patients, ganciclovir has become established as the treatment of choice for symptomatic CMV infection and CMV disease in thoracic transplant recipients, although no placebo-controlled trials have been published in this patient group. All patients at risk of CMV disease by virtue of CMV seropositivity in either donor or recipient should be monitored at least weekly with either the antigenaemia assay or PCR.
All patients were followed for 3 months.