Effect of Preemptive Therapy vs Antiviral Prophylaxis on Cytomegalovirus Disease in Seronegative Liver Transplant Recipients With Seropositive Donors: A Randomized Clinical Trial
RCT (n=205) found a significantly lower incidence of CMV disease with pre-emptive therapy (valganciclovir, 900mg, twice daily until 2 consecutive negative tests a week apart) vs antiviral prophylaxis (valganciclovir, 900mg, daily for 100 days) - 9% vs 19%, p=0.04.
Source:
Journal of the American Medical Association
SPS commentary:
A related editorial note states that the result was primarily due to a reduction in delayed-onset disease (6% for pre-emptive therapy vs 17% for antiviral prophylaxis). It also notes that while these results provide some clarity regarding the use of pre-emptive therapy, several caveats remain. Pre-emptive therapy requires weekly monitoring by serum polymerase chain reaction and immediate initiation of antivirals when indicated. Transplant centers may differ in their capacity to support such frequent measures, and some patients may find these requirements costly, and logistically burdensome, especially if this specialised test is not easily available locally. It concludes that despite these limitations, pre- emptive therapy may be a viable option for preventing CMV infection among selected high-risk patients following liver transplant.