Criteria for patient selection
For prevention of CMV disease in high risk transplant patients identified as follows:
Renal and Simultaneous kidney-pancreas transplant (SKP) - All transplant recipients except CMV –ve recipients of CMV –ve donors
Valganciclovir has replaced Ganciclovir for prevention of CMV disease. Prescriptions will be initiated in hospital within 10 days of transplantation. Therapy will be continued in primary care for up to a total of 180 days treatment for which a shared-care protocol will be provided.
The initial valganciclovir dose is dependent on renal function as shown in the table below:
| Creatinine clearance (ml/min) | Prophylactic dose |
| >60 | 900mg od |
| 40 to 59 | 450mg od |
| 25 to 39 | 450mg every 2 days |
| 10 to 24 | 450mg twice weekly |
| <10 | 100mg three times weekly after dialysis |
Valganciclovir is available as 450mg tablets (pink) or as an oral solution and the brand name is Valcyte. The tablets should be taken with food and not broken or crushed.
FBC and LFTs must be monitored daily during therapy.
Leucopenia can occur with valganciclovir treatment and this is a common cause for discontinuing the drug prematurely.
Note: Surveillance for CMV post - transplant is not performed routinely in the Unit.
Investigation of any episode of illness which might be CMV related, at any stage following a transplant operation.
- An EDTA (9 ml or 3 x 2.5 mls 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 and CMV culture. Please try to ensure samples reach Virus Lab by midday. The rapid culture may provide an answer sooner than PCR in some cases.
- It will often be appropriate to send respiratory or other samples to virology - bronchoalveolar lavage or induced sputum for investigation as usual or colon biopsies.
Treatment of CMV disease
Patients in whom the diagnosis of CMV disease has been made with positive CMV PCR should be treated with 2 weeks IV ganciclovir followed by oral valgangiglovir. This should be continued until two consecutive negative CMV results have been obtained.
Dose of IV gancyclovir will depend on creatinine clearance:
| Creatinine clearance (ml/min) | Prophylactic dose |
| >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 |
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