Ganciclovir effectively treats cytomegalovirus disease after solid-organ transplantation, even during rejection treatment.
Ganciclovir (DHPG) was used to treat eight patients with severe cytomegalovirus (CMV) disease after renal transplantation. Four had generalized disease, one had severe recurrent gastrointestinal bleeding and three had interstitial pneumonia. All patients responded to treatment, symptoms disappearing within 7 days (range: 3-22 days). Leukocytopenia and confusion were the main side-effects, both occurring in three patients. Encouraged by the effectiveness and the mild side-effects of ganciclovir we enlarged the indication for treatment. Five patients with CMV disease and concomitant rejection were treated with ganciclovir together with antirejection therapy. Four patients received methylprednisolone, one patient anti thymocyte globulin. CMV-related symptoms disappeared in all five patients. The only side-effect observed was a mild leukocytopenia in one patient. Renal function was preserved in three of the five patients. The virological response to the drug was also evaluated. Twelve patients had positive cultures in blood and/or urine before ganciclovir was started. In three patients the cultures became negative during follow-up. In eight patients cultures remained positive after ganciclovir treatment although in seven of these CMV had initially been absent from blood and/or urine. We conclude that ganciclovir treatment is clinically effective in severe CMV disease and that treatment with ganciclovir makes antirejection therapy during CMV disease possible.