Clinical

Ganciclovir for CMV prophylaxis also reduces bacteremia

Last Updated: 2004-11-11 15:32:32 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Liver transplant recipients who receive ganciclovir for prophylaxis of cytomegalovirus have a reduced risk of bacteremia, according to a report in the November 1st issue of Clinical Infectious Diseases.

At the Tufts-New England Medical Center in Boston, Dr. L. Silvia Munoz-Price and colleagues evaluated the impact of ganciclovir prophylaxis on bacteremia rates in 192 consecutive liver transplant recipients.

Between 1994 and 1996 at the authors' transplant program, ganciclovir was given for 14 days only to high-risk patients (cytomegalovirus-negative recipients of livers from cytomegalovirus-positive donors). From 1997 on, all patients, regardless of cytomegalovirus status, received 120 days of prophylaxis. Nine patients died during the 2-year follow-up period.

Fifty-nine episodes of bacteremia occurred in 29 patients.

On univariate analysis, risk factors for bacteremia included invasive fungal disease, initial antilymphocyte immunosuppression, treatment for rejection, and administration of Solu-Medrol.

Factors associated with a lowered risk for bacteremia included at least 14 days of ganciclovir prophylaxis, use of end-to-end anastomosis, and intraoperative use of no more than 9 units of red blood cells.

When the researchers controlled for end-to-end anastomosis and intraoperative transfusion, they found that at least "14 days of ganciclovir was still associated with a reduced risk of bacteremia," with a hazard ratio of 0.44.

"The use of ganciclovir as the standard of care for liver transplant recipients, regardless of their cytomegalovirus infection status, reduces the rate of bacteremia," the authors conclude.

Clin Infect Dis 2004;39:1293-1299