Low-Dose Valacyclovir for Cytomegalovirus Infection Prophylaxis After a Heart Transplant

Exp Clin Transplant. 2016 Oct;14(5):551-554. doi: 10.6002/ect.2015.0109. Epub 2016 Mar 14.

Abstract

Objectives: Cytomegalovirus infection is a major cause of morbidity and mortality in solid-organ transplant. Low doses of valacyclovir have been administered as cytomegalovirus prophylaxis in our institution for years. To the best of our knowledge, there is no published study of a low-dose regimen for cytomegalovirus prophylaxis in heart transplant patients. Therefore, our aim was to determine the results of low doses of valacyclovir in heart transplant.

Materials and methods: Between September 2006 and December 2014, sixty-eight patients underwent orthotopic heart transplants. All of the patients received triple immunosuppressive therapy after surgery. During the next 6 months, sulfamethoxazole/trimethoprim was administered for Pneumocystis jiroveci pneumonia, and toxoplasmosis. Additionally all patients received valacyclovir hydrochloride (1000 mg/d, oral) for cytomegalovirus prophylaxis and nystatin oral rinse for prophylaxis of fungal infections.

Results: There was only 1 cytomegalovirus infection at follow-up. The patient had cytomegalovirus pneumonia at 17-month follow-up. In response to treatment with 1-week intravenous ganciclovir, the patient was discharged with a further 6-month oral valacyclovir therapy (1000 mg/d).

Conclusions: In this study, we hypothesized that daily use of low-dose valacyclovir (1000 mg/d) is not only sufficient for cytomegalovirus prophylaxis but also beneficial in terms of cost.

MeSH terms

  • Acyclovir / administration & dosage
  • Acyclovir / adverse effects
  • Acyclovir / analogs & derivatives*
  • Adolescent
  • Adult
  • Antiviral Agents / administration & dosage*
  • Antiviral Agents / adverse effects
  • Cytomegalovirus / drug effects*
  • Cytomegalovirus / immunology
  • Cytomegalovirus / pathogenicity
  • Cytomegalovirus Infections / diagnosis
  • Cytomegalovirus Infections / immunology
  • Cytomegalovirus Infections / prevention & control*
  • Cytomegalovirus Infections / virology
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Female
  • Heart Transplantation / adverse effects*
  • Humans
  • Immunocompromised Host
  • Immunosuppressive Agents / administration & dosage
  • Immunosuppressive Agents / adverse effects*
  • Male
  • Middle Aged
  • Opportunistic Infections / diagnosis
  • Opportunistic Infections / immunology
  • Opportunistic Infections / prevention & control*
  • Opportunistic Infections / virology
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / immunology
  • Pneumonia, Viral / prevention & control*
  • Pneumonia, Viral / virology
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Valacyclovir
  • Valine / administration & dosage
  • Valine / adverse effects
  • Valine / analogs & derivatives*
  • Virus Activation / drug effects
  • Young Adult

Substances

  • Antiviral Agents
  • Immunosuppressive Agents
  • Valine
  • Valacyclovir
  • Acyclovir