Clinical Immunotherapeutics

, Volume 5, Issue 1, pp 13–29 | Cite as

Prophylaxis and Treatment of Cytomegalovirus Infection after Solid Organ Transplantation

  • Robin Patel
  • Russell H. Wiesner
  • Carlos V. Paya
Disease Management

Summary

Cytomegalovirus (CMV) infection occurs in the majority of patients following solid organ transplantation. The mainstay of treatment for symptomatic CMV infection in this patient population is intravenous ganciclovir and, to a lesser extent, foscarnet. Methods of preventing CMV infection include: (i) protective matching; (ii) use of CMV-seronegative, filtered or leucocyte-poor blood products; (iii) active immunisation with a vaccine; (iv) passive immunisation with immunoglobulins; (v) prophylaxis with antiviral agents such as interferons, aciclovir (acyclovir), ganciclovir or foscarnet; and (vi) pre-emptive therapy.

Protective matching is not feasible due to the scarcity of donor organs. CMV-seronegative, filtered or leucocyte-poor blood products should be used, at least in seronegative recipients. A live attenuated CMV vaccine has been shown to be of limited efficacy in preventing CMV disease in renal transplantation recipients; however, a subunit vaccine is in development. Prophylaxis with immunoglobulins has been shown to be effective in some solid organ transplantation populations; however, the cost of such an approach is considerable. Of the antiviral agents, intravenous ganciclovir is the only agent that has been shown to have some degree of prophylactic efficacy in the majority of solid organ transplantation recipients. However, the cost and need for intravenous access make intravenous ganciclovir a suboptimal prophylactic agent. Several newer drugs, including oral agents, are currently being studied in this mode. Pre-emptive therapy, based either on the early detection of CMV or the targeting of patients with risk factors for CMV, appears to be a promising new approach.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Dummer JS, Hardy A, Poorsattar A, et al. Early infections in kidney, heart, and liver transplant recipients on cyclosporin. Transplantation 1983; 36: 259–67PubMedCrossRefGoogle Scholar
  2. 2.
    Ho M. Advances in understanding cytomegalovirus infection after transplantation. Transplant Proc 1994; 26: 7–11PubMedGoogle Scholar
  3. 3.
    Stratta RJ. Clinical patterns and treatment of cytomegalovirus infection after solid-organ transplantation. Transplant Proc 1993; 25 Suppl.4: 15–21PubMedGoogle Scholar
  4. 4.
    Rook AH. Interactions of cytomegalovirus with the human immune system. Rev Infect Dis 1988; 10 Suppl. 3: S460–7PubMedCrossRefGoogle Scholar
  5. 5.
    Fox AS, Tolpin MD, Baker AL, et al. Seropositivity in liver transplantation recipients as a predictor of cytomegalovirus disease. J Infect Dis 1988; 157: 383–4PubMedCrossRefGoogle Scholar
  6. 6.
    Rubin RH. The indirect effects of cytomegalovirus infection on the outcome of organ transplantation. JAMA 1989; 261: 3607–9PubMedCrossRefGoogle Scholar
  7. 7.
    van Son WJ, van der Berg AP, The TH, et al. Preemptive therapy with ganciclovir for early high-risk CMV infection allows effective treatment with antithymocyte globulin of steroid-resistant rejection after renal transplantation. Transplant Proc 1993; 25: 1436–8PubMedGoogle Scholar
  8. 8.
    Boudreaux JP, Hayes DH, Mizrahi S, et al. Decreasing incidence of serious cytomegalovirus infection using ganciclovir prophylaxis in pediatric liver transplant patients. Transplant Proc 1993; 25: 1872PubMedGoogle Scholar
  9. 9.
    McCaughan GW, McDonald JA, Davies S, et al. Clinicopathological approach to human liver allograft dysfunction. J Gastroenterol Hepatol 1989; 4: 467–77PubMedCrossRefGoogle Scholar
  10. 10.
    Shuster EA, Beneke JS, Tegmeier GE, et al. Monoclonal antibody for rapid laboratory detection of cytomegalovirus infections: characterization and diagnostic application. Mayo Clin Proc 1985; 60: 577–85PubMedCrossRefGoogle Scholar
  11. 11.
    Van den Berg AP, Klimpmaker IJ, Haagsma EB, et al. Antigenemia in the diagnosis and monitoring of active cytomegalovirus infection after liver transplantation. J Infect Dis 1991; 164: 265–70PubMedCrossRefGoogle Scholar
  12. 12.
    Van der Bij W, Schirm J, Torensma R, et al. Comparison between viremia and antigenemia for detection of cytomegalovirus in blood. J Clin Microbiol 1988; 26: 2531–5PubMedGoogle Scholar
  13. 13.
    Erice A, Holm MA, Gill PC, et al. Cytomegalovirus (CMV) antigenemia assay is more sensitive than shell vial cultures for rapid detection of CMV in polymorphonuclear blood leukocytes. J Clin Microbiol 1992; 30: 2822–5PubMedGoogle Scholar
  14. 14.
    Delgado R, Lumbreras C, Alba C, et al. Low predictive value of polymerase chain reaction for diagnosis of CMV disease in liver transplant recipients. J Clin Microbiol 1992; 30: 1876–8PubMedGoogle Scholar
  15. 15.
    Patel R, Smith TF, Espy M, et al. Detection of cytomegalovirus DNA in sera of liver transplant recipients. J Clin Microbiol 1994; 32: 1431–4PubMedGoogle Scholar
  16. 16.
    Spector SA, Merrill R, Wolf D, et al. Detection of human cytomegalovirus in plasma of AIDS patients during acute visceral disease by DNA amplification. J Clin Microbiol 1992; 30: 2359–65PubMedGoogle Scholar
  17. 17.
    Bitsch A, Kirchner H, Dupke R, et al. Cytomegalovirus transcripts in peripheral blood leukocytes of actively infected transplant patients detected by reverse transcription-polymerase chain reaction. J Infect Dis 1993; 167: 740–3PubMedCrossRefGoogle Scholar
  18. 18.
    Paya CV, Smith TF, Ludwig J, et al. Rapid shell vial culture and tissue histology compared with serology for the rapid diagnosis of cytomegalovirus infection in liver transplantation. Mayo Clin Proc 1989; 64: 670–5PubMedCrossRefGoogle Scholar
  19. 19.
    Smith TF, Shelley CD. Detection of IgM antibody to cytomegalovirus and rapid detection of this virus infection by the shell vial assay. J Virol Methods 1988; 21: 87–96PubMedCrossRefGoogle Scholar
  20. 20.
    Marsano L, Perillo RP, Flye MW, et al. Comparison of culture and serology for the diagnosis of cytomegalovirus infection in kidney and liver transplant recipients. J Infect Dis 1990; 161: 454–61PubMedCrossRefGoogle Scholar
  21. 21.
    Littler E, Stuart AD, Cree MS. Human cytomegalovirus UL97 open reading frame encodes a protein that phosphorylates the antiviral analogue ganciclovir. Nature 1992; 358: 160–2PubMedCrossRefGoogle Scholar
  22. 22.
    Sullivan V, Talarico CL, Stanat SC, et al. A protein kinase homologue controls phosphorylation of ganciclovir in human cytomegalovirus-infected cells. Nature 1992; 358: 162–4PubMedCrossRefGoogle Scholar
  23. 23.
    Keating MR. Antiviral agents. Mayo Clin Proc 1992; 67: 160–78PubMedCrossRefGoogle Scholar
  24. 24.
    Stratta RJ, Shaefer MS, Markin RS, et al. Clinical patterns of cytomegalovirus disease after liver transplantation. Arch Surg 1989; 142: 1433–50Google Scholar
  25. 25.
    Gudnason T, Belani KK, Balfour HH. Ganciclovir treatment of cytomegalovirus disease in immunocompromised children. Pediatr Infect Dis 1989; 8: 436–40Google Scholar
  26. 26.
    Mai M, Nery J, Sutker W, et al. DHPG (ganciclovir) improves survival in CMV pneumonia. Transplant Proc 1989; 21: 2263–5PubMedGoogle Scholar
  27. 27.
    D’Allesandro AM, Pirsch JD, Stratta RJ, et al. Successful treatment of severe cytomegalovirus infections with ganciclovir and CMV hyperimmune globulin in liver transplant recipients. Transplant Proc 1989; 21: 3560–1Google Scholar
  28. 28.
    Salmela K, Hocherstedt K, Lautenschlager I, et al. Ganciclovir in the treatment of severe cytomegalovirus disease in liver transplant patients. Transplant Proc 1990; 22: 238–40PubMedGoogle Scholar
  29. 29.
    de Hemptinne B, Lamy ME, Salizzoni M, et al. Successful treatment of cytomegalovirus disease with 9-(l,3-dihydroxy-2-propoxymethyl guanine). Transplant Proc 1988; 20: 652–5PubMedGoogle Scholar
  30. 30.
    Buhles WC, Mastre BJ, Tinker AJ, et al. Ganciclovir treatment of life- or sight-threatening cytomegalovirus infection: experience in 314 immunocompromised patients. Rev Infect Dis 1988; 106: S495–506CrossRefGoogle Scholar
  31. 31.
    de Koning J, van Dorp WT, van Es LA, et al. Ganciclovir effectively treats cytomegalovirus disease after solid-organ transplantation, even during rejection treatment. Nephrol Dial Transplant 1992; 7: 350–6PubMedGoogle Scholar
  32. 32.
    Lang P, Buisson C, Rostoker G, et al. DHPG treatment of kidney transplant recipients with severe CMV infection. Transplant Proc 1989; 21: 2084–6PubMedGoogle Scholar
  33. 33.
    Guerin C, Pozzetto B, Broyet C, et al. Ganciclovir therapy of symptomatic cytomegalovirus infection in renal transplant recipients. Nephrol Dial Transplant 1989; 4: 906–10PubMedGoogle Scholar
  34. 34.
    Jordan ML, Hrebinko Jr RL, Dummer JS, et al. Therapeutic use of ganciclovir for invasive cytomegalovirus infection in cadaveric renal allograft recipients. J Urol 1992; 148: 1388–92PubMedGoogle Scholar
  35. 35.
    Nicholson ML, Veitch PS, Donnelly PK, et al. Treatment of renal transplant-associated cytomegalovirus infection with ganciclovir. Transplant Proc 1990; 22: 1811–2PubMedGoogle Scholar
  36. 36.
    Cerrina J, Bavoux E, Ladurie FL, et al. Ganciclovir treatment of cytomegalovirus infection in heart-lung and double-lung transplant recipients. Transplant Proc 1991; 23: 1174–5PubMedGoogle Scholar
  37. 37.
    Cooper DKC, Novitzky D, Schlegel V, et al. Successful management of symptomatic cytomegalovirus disease with ganciclovir after heart transplantation. J Heart Lung Transplant 1991; 10: 656–63PubMedGoogle Scholar
  38. 38.
    Icenogle TB, Peterson E, Ray G, et al. DHPG effectively treats CMV infection in heart and heart-lung transplant patients: a preliminary report. J Heart Transplant 1987; 6: 199–203PubMedGoogle Scholar
  39. 39.
    Keay S, Petersen E, Icenogle T, et al. Ganciclovir treatment of serious cytomegalovirus infection in heart and heart-lung transplant recipients. Rev Infect Dis 1988; 10 Suppl. 3: S563–72PubMedCrossRefGoogle Scholar
  40. 40.
    Snydman DR. Ganciclovir therapy for cytomegalovirus disease associated with renal transplants. Rev Infect Dis 1988; 10 Suppl. 3: S554–62PubMedCrossRefGoogle Scholar
  41. 41.
    Rondeau E, Farquet C, Ruedin P, et al. Efficacy of early treatment of cytomegalovirus infection by ganciclovir in renal transplant recipients. Transplant Proc 1990; 22: 1813–4PubMedGoogle Scholar
  42. 42.
    Hrebinko R, Jordan ML, Dummer JS, et al. Ganciclovir for invasive cytomegalovirus infection in renal allograft recipients. Transplant Proc 1991; 23: 1346–7PubMedGoogle Scholar
  43. 43.
    Watson FS, O’Connell JB, Amber IJ, et al. Treatment of cytomegalovirus pneumonia in heart transplant recipients with 9-(l,3-dihydroxy-2-proproxymethyl)-guanine (DHPG). J Heart Transplant 1988; 7: 102–5PubMedGoogle Scholar
  44. 44.
    Steinhoff G, Behrend M, Wagner TOF, et al. Early diagnosis and effective treatment of pulmonary CMV infection after lung transplantation. J Heart Lung Transplant 1991; 10: 9–14PubMedGoogle Scholar
  45. 45.
    Smyth RL, Scott JP, Borysiewicz LK, et al. Cytomegalovirus infection in heart-lung transplant recipients: risk factors, clinical associations, and response to treatment. J Infect Dis 1991; 164: 1045–50PubMedCrossRefGoogle Scholar
  46. 46.
    Dunn DL, Mayoral JL, Gillingham KJ, et al. Treatment of invasive cytomegalovirus disease in solid organ transplant patients with ganciclovir. Transplantation 1991; 51: 98–106PubMedCrossRefGoogle Scholar
  47. 47.
    Megison SM, Andrews WS. Combination therapy with ganciclovir and intravenous IgG for cytomegalovirus infections in pediatric liver transplant recipients. Transplantation 1991; 52: 151–4PubMedCrossRefGoogle Scholar
  48. 48.
    Stein DS, Verano AS, Levandowski RA. Successful treatment with ganciclovir of disseminated cytomegalovirus infection after liver transplantation. Am J Gastroenterol 1988; 83: 684–6PubMedGoogle Scholar
  49. 49.
    Paya CV, Hermans PE, Smith TF, et al. Efficacy of ganciclovir in liver and kidney transplant recipients with severe cytomegalovirus infection. Transplantation 1988; 46: 229–34PubMedCrossRefGoogle Scholar
  50. 50.
    Markin RS, Langnas AN, Donovan JP, et al. Opportunistic viral hepatitis in liver transplant recipients. Transplant Proc 1991; 23: 1520–1PubMedGoogle Scholar
  51. 51.
    Winston DJ, Ho WG, Bartomi K, et al. Ganciclovir therapy for cytomegalovirus infections in recipients of bone marrow transplants and other immunosuppressed patients. Rev Infect Dis 1988; 10: S547–53PubMedCrossRefGoogle Scholar
  52. 52.
    Erice A, Jordan MC, Chace BA, et al. Ganciclovir treatment of cytomegalovirus disease in transplant recipients and other immunocompromised hosts. JAMA 1987; 257: 3082–7PubMedCrossRefGoogle Scholar
  53. 53.
    Harbison MA, De-Girolami PC, Jenkins RL, et al. Ganciclovir therapy of severe cytomegalovirus infections in solid-organ transplant recipients. Transplantation 1988; 46: 82–8PubMedCrossRefGoogle Scholar
  54. 54.
    O’Hair DP, Johnson CP, Roza AM, et al. Treatment of transplant rejection in the presence of cytomegalovirus viremia. Transplant Proc 1990; 22: 1815–7PubMedGoogle Scholar
  55. 55.
    Ross CN, Reynon HLC, Savill JS, et al. Ganciclovir treatment for cytomegalovirus infection in immunocompromised patients with renal disease. Q J Med 1991; 81: 929–36PubMedGoogle Scholar
  56. 56.
    Stratta R, Shaefer M, Markin R, et al. Ganciclovir therapy for viral disease in liver transplant recipients. Transplant Proc 1991; 23: 1968PubMedGoogle Scholar
  57. 57.
    Reed EC, Wolford JL, Kopecky KJ, et al. Ganciclovir for the treatment of cytomegalovirus gastroenteritis in bone marrow transplant patients. Ann Intern Med 1990; 112: 505–10PubMedGoogle Scholar
  58. 58.
    Swan SK, Munar MY, Wigger MA, et al. Pharmacokinetics of ganciclovir in a patient undergoing hemodialysis. Am J Kidney Dis 1991; 17: 69–72PubMedGoogle Scholar
  59. 59.
    Sayage LH, Gonwa TA, Goldstein RM, et al. Cytomegalovirus infection in orthotopic liver transplantation. Transplant Int 1989; 2: 96–101Google Scholar
  60. 60.
    Davis CL, Springmeyer S, Gmerek BJ. Central nervous system side effects of ganciclovir. N Engl J Med 1990; 322: 933–4PubMedCrossRefGoogle Scholar
  61. 61.
    Shea BF, Hoffman S, Sesin GP, et al. Ganciclovir hepatotoxicity. Pharmacotherapy 1987; 7: 223–6PubMedGoogle Scholar
  62. 62.
    Faulds D, Heel RC. Ganciclovir. A review of its antiviral activity, pharmacokinetic properties and therapeutic efficacy in cytomegalovirus infections. Drugs 1990; 39: 597–638PubMedCrossRefGoogle Scholar
  63. 63.
    Buhles WC, Mastre BJ, Tinker AJ. Ganciclovir treatment of life- or sight-threatening cytomegalovirus infection: experience in 314 immunocompromised patients. Rev Infect Dis 1988; 10: S495–506PubMedCrossRefGoogle Scholar
  64. 64.
    Dunn DL, Mayoral JL, Gillingham KJ, et al. Treatment of invasive cytomegalovirus disease in solid organ transplant patients with ganciclovir. Transplantation 1991; 51: 98–106PubMedCrossRefGoogle Scholar
  65. 65.
    De Armond B. Safety considerations in the use of ganciclovir in immunocompromised patients. Transplant Proc 1991; 23 Suppl. 1: 26–9Google Scholar
  66. 66.
    Boivin G, Erice A, Crane DD, et al. Ganciclovir susceptibilities of cytomegalovirus (CMV) isolates from solid organ transplant recipients with CMV viremia after antiviral prophylaxis. J Infect Dis 1993; 168: 322–5CrossRefGoogle Scholar
  67. 67.
    Einsele H, Ehninger G, Steidle M, et al. Polymerase chain reaction to evaluate antiviral therapy for cytomegalovirus disease. Lancet 1991; 338: 1170–2PubMedCrossRefGoogle Scholar
  68. 68.
    van den Berg AP, van Son WJ, Haagsma EB, et al. Prediction of recurrent cytomegalovirus disease after treatment with ganciclovir in solid-organ transplant recipients. Transplantation 1993; 55: 847–51PubMedCrossRefGoogle Scholar
  69. 69.
    Sawyer MD, Mayoral JL, Gillingham KJ, et al. Treatment of recurrent cytomegalovirus disease in patients receiving solid organ transplants. Arch Surg 1993; 128: 165–70PubMedCrossRefGoogle Scholar
  70. 70.
    Klintmalm G, Lonnqvist B, Oberg B, et al. Intravenous foscarnet for the treatment of severe cytomegalovirus infection in allograft recipients. Scand J Infect Dis 1985; 17: 157–63PubMedGoogle Scholar
  71. 71.
    Barkholt LM, Ericzon BG, Ehrnst A, et al. Cytomegalovirus infections in liver transplant patients: incidence and outcome. Transplant Proc 1990; 22: 235–7PubMedGoogle Scholar
  72. 72.
    Ringden O, Lonnqvist B, Paulin T, et al. Pharmacokinetics, safety and preliminary clinical experiences using foscarnet in the treatment of cytomegalovirus infections in bone marrow and renal transplant recipients. J Antimicrob Chemother 1986; 17: 373–87PubMedCrossRefGoogle Scholar
  73. 73.
    Locke TJ, Odom NJ, Tapson JS, et al. Successful treatment with trisodium phosphonoformate for primary cytomegalovirus infection after heart transplantation. J Heart Transplant 1987; 6: 120–2PubMedGoogle Scholar
  74. 74.
    Manischewits JE, Guinnan GV, Lane HC, et al. Synergistic effect of ganciclovir and foscarnet on cytomegalovirus replication in vitro. Antimicrob Agents Chemother 1990; 34: 373–5CrossRefGoogle Scholar
  75. 75.
    Wade JC, Hintz M, McGuffin RW, et al. Treatment of cytomegalovirus pneumonia with high dose acyclovir. Am J Med 1982; 73: 249–56PubMedCrossRefGoogle Scholar
  76. 76.
    Burdelski M, Schmidt K, Hoyer PF, et al. Liver transplantation in children: the Hanover experience. Transplant Proc 1987; 19: 3277–81PubMedGoogle Scholar
  77. 77.
    Lautenschlager I, Ahonen J, Eklund B, et al. Hyperimmune globulin therapy of clinical CMV disease in renal allograft recipients. Transplant Proc 1989; 21: 2087–8PubMedGoogle Scholar
  78. 78.
    Rancewicz Z, Halama G, Smogorzewski M, et al. The usefulness of hyperimmune globulin for treatment of overt cytomegalovirus infection in allograft recipients. Transplant Proc 1990; 22: 1818–9PubMedGoogle Scholar
  79. 79.
    Stratta RJ, Wood RP, Langnas RM, et al. Donor selection for orthotopic liver transplantation: lack of an effect of gender of cytomegalovirus (CMV) status. Transplant Proc 1990; 22: 410–3PubMedGoogle Scholar
  80. 80.
    Bowden RA, Sayers MH, Cays M, et al. The role of blood product filtration in the prevention of transfusion associated cytomegalovirus (CMV) infection after marrow transplant [abstract no. S205]. Transfusion 1989; 27: 575Google Scholar
  81. 81.
    Sayers MH, Anderson KC, Goodnough LT, et al. Reducing the risk for transfusion-transmitted cytomegalovirus infection. Ann Intern Med 1992; 116: 55–62PubMedGoogle Scholar
  82. 82.
    Milbradt H, Flik J, Stangel W, et al. Bedeutung der Untersuchung auf Antikorper gegen Cycomegalievirus bei Organtransplantationen. Beitr Infusionsther 1990; 26: 33–6PubMedGoogle Scholar
  83. 83.
    Rakela J, Wiesner RH, Taswell HF, et al. Incidence of cytomegalovirus infection and its relationship to donor-recipient serologic status in liver transplantation. Transplant Proc 1987; 19: 2399–402PubMedGoogle Scholar
  84. 84.
    Marker SC, Simmons RL, Balfour Jr HH. Cytomegalovirus vaccine in renal allograft recipients. Transplant Proc 1981; 13: 117–9PubMedGoogle Scholar
  85. 85.
    Balfour Jr HH, Sachs GW, Welo P, et al. Cytomegalovirus vaccine in renal transplant candidates: progress report of a randomized, placebo-controlled, double-blind trial. Birth Defects 1984; 20: 289–304PubMedGoogle Scholar
  86. 86.
    Balfour Jr HH, Welo PK, Sachs GW. Cytomegalovirus vaccine trial in 400 renal transplant candidates. Transplant Proc 1985; 17: 81–3Google Scholar
  87. 87.
    Glazer JP, Friedman HM, Grossman RA, et al. Live cytomegalovirus vaccination of renal transplant candidates. A preliminary trial. Ann Intern Med 1979; 91: 676–83PubMedGoogle Scholar
  88. 88.
    Plotkin SA, Huang E-S. Cytomegalovirus vaccine virus (Towne strain) does not induce latency. J Infect Dis 1985; 152: 395–7PubMedCrossRefGoogle Scholar
  89. 89.
    Brayman KL, Dafoe DC, Smythe WR, et al. Prophylaxis of serious cytomegalovirus infection in renal transplant candidates using live human cytomegalovirus vaccine. Arch Surg 1988; 123: 1502–8PubMedCrossRefGoogle Scholar
  90. 90.
    Plotkin SA, Starr SE, Friedman HM, et al. Effect of Towne live virus vaccine on cytomegalovirus disease after renal transplant. Ann Intern Med 1991; 114: 525–31PubMedGoogle Scholar
  91. 91.
    Plotkin SA, Friedman HM, Fleisher GR, et al. Towne-vaccine-induced prevention of cytomegalovirus disease after renal transplants. Lancet 1984; i: 528–30CrossRefGoogle Scholar
  92. 92.
    Plotkin SA, Gonczol E, Starr SE. Subunit vaccine against human cytomegalovirus (HCMV) [abstract no. 735]. Proceedings of Interscience Conference on Antimicrobial Agents and Chemotherapy, 1988Google Scholar
  93. 93.
    Adler SP. Development and clinical status of cytomegalovirus vaccines. Clin Immunother 1994; 2(1): 1–6CrossRefGoogle Scholar
  94. 94.
    Britt W, Fay J, Seals J, et al. Formulation of an immunogenic human cytomegalovirus vaccine: responses in mice. J Infect Dis 1995; 171: 18–25PubMedCrossRefGoogle Scholar
  95. 95.
    Bjøro K, Frøland SS, Yun Z, et al. Hepatitis C infection in patients with hypogammaglobulinemia after treatment with contaminated immune globulin. N Engl J Med 1994; 331: 1607–11PubMedCrossRefGoogle Scholar
  96. 96.
    Gorensek MJ, Carey WD, Vogt D, et al. A multivariate analysis of risk factors for cytomegalovirus infection in liver transplant recipients. Gastroenterology 1987; 156: 273–9Google Scholar
  97. 97.
    Pan SH, Rosenthal P, Howard TK, et al. Evaluation of three cytomegalovirus infection prophylactic regimens in liver transplant recipients. Transplant Proc 1992; 24: 1466–7PubMedGoogle Scholar
  98. 98.
    Dussaix E, Wood C. Cytomegalovirus infection in pediatric liver recipients: a virologic survey and prophylaxis with CMV immunoglobulin and early DHPG treatment. Transplantation 1989; 48: 272–4PubMedCrossRefGoogle Scholar
  99. 99.
    Cofer JB, Morris CA, Sutker WL, et al. A randomized double-blind study of the effect of prophylactic immune globulin on the incidence and severity of CMV infection in the liver transplant recipient. Transplant Proc 1991; 23: 1525–7PubMedGoogle Scholar
  100. 100.
    Snydman DR, Werner BG, Dougherty NN, et al. for the Boston Center for Liver Transplantation CMVIG Study Group. Cytomegalovirus immune globulin prophylaxis in liver transplantation: a randomized, double blind, placebo-controlled trial. Ann Intern Med 1993; 10: 984–91Google Scholar
  101. 101.
    Bell R, Sheil AGR, McDonald JA, et al. The role of CMV immune prophylaxis in patients at risk of primary CMV infection following orthotopic liver transplantation. Transplant Proc 1989; 21: 3781–2PubMedGoogle Scholar
  102. 102.
    Saliba F, Gugenheim J, Samuel D, et al. Incidence of cytomegalovirus infection and effects of cytomegalovirus immune globulin prophylaxis after orthotopic liver transplantation. Transplant Proc 1987; 19: 4081–2PubMedGoogle Scholar
  103. 103.
    Saliba F, Arulnaden JL, Gugenheim J, et al. CMV hyperimmune globulin prophylaxis after liver transplantation: a prospective randomized controlled study. Transplant Proc 1989; 21: 2260–2PubMedGoogle Scholar
  104. 104.
    Stratta RJ, Shaeffer MS, Cushing KA, et al. Successful prophylaxis of cytomegalovirus disease after primary CMV exposure in liver transplant recipients. Transplantation 1991; 51: 90–7PubMedCrossRefGoogle Scholar
  105. 105.
    Stratta RJ, Shaeffer MS, Cushing KA, et al. A randomized prospective trial of acyclovir and immune globulin prophylaxis in liver transplant recipients receiving OKT3 therapy. Arch Surg 1992; 127: 55–64PubMedCrossRefGoogle Scholar
  106. 106.
    Kaden J, Scholz D, Eichler C, et al. Frequency of infection with cytomegaloviruses (CMV) following kidney transplantation and initial experiences with CMV gamma globulin prevention. Immun Infekt 1985; 13: 290–5PubMedGoogle Scholar
  107. 107.
    Greger B, Vallbracht A, Kurth J, et al. The clinical value of CMV prophylaxis by CMV hyperimmune serum in the kidney transplant patient. Transplant Proc 1986; 18: 1387–9Google Scholar
  108. 108.
    Snydman DR, Werner BG, Heinze-Lacey B, et al. Use of cytomegalovirus immune globulin to prevent cytomegalovirus disease in renal-transplant recipients. N Engl J Med 1987; 317: 1049–54PubMedCrossRefGoogle Scholar
  109. 109.
    Grundmann R, Wienand P, Runde A, et al. Cytomegalovirus hyperimmunoglobulin prophylaxis following kidney transplantation. Results of a prospective randomized study. Dtsch Med Wochenschr 1987; 112: 827–31PubMedCrossRefGoogle Scholar
  110. 110.
    Light JA, Khawand N, Brems W, et al. Does IVIG prevent primary CMV disease in kidney transplant recipients, [abstract]. American Academy of Transplant Physicians Annual Meeting, Chicago, 1988Google Scholar
  111. 111.
    Fehir KM, Decker WA, Samo T, et al. Immune globulin (Gammagard) prophylaxis of CMV infections in patients undergoing organ transplantation and allogenic bone marrow transplantation. Transplant Proc 1989; 21: 3107–9PubMedGoogle Scholar
  112. 112.
    Kasiske BL, Heim-Duthoy KL, Tortorice KL, et al. Polyvalent immune globulin and cytomegalovirus infection after renal transplantation. Arch Intern Med 1989; 149: 2733–6PubMedCrossRefGoogle Scholar
  113. 113.
    Metselaar HJ, Rothbarth PH, Brouwer RM, et al. Prevention of cytomegalovirus-related death by passive immunization. A double-blind placebo-controlled study in kidney transplant recipients treated by rejection. Transplantation 1989; 48: 264–6PubMedCrossRefGoogle Scholar
  114. 114.
    Steinmuller DR, Novick AC, Streem SB, et al. Intravenous immunoglobulin infusions for the prophylaxis of secondary cytomegalovirus infection. Transplantation 1990; 49: 68–70PubMedCrossRefGoogle Scholar
  115. 115.
    Cofer JB, Morris CA, Sutker BS, et al. A randomized double-blind study of the effect of prophylactic immune globulin on the incidence and severity of CMV infection in the liver transplant recipient. Transplant Proc 1983; 15: 1405–11Google Scholar
  116. 116.
    Conti DJ, Freed BM, Gruber SA, et al. Prophylaxis of primary cytomegalovirus disease in renal transplant patients. Arch Surg 1994; 129: 443–7PubMedCrossRefGoogle Scholar
  117. 117.
    Finn WF. CMV-enriched immune globulin produces consistent reliable results in renal transplant patients. Transplantation 1993; 56: 491–3PubMedCrossRefGoogle Scholar
  118. 118.
    Werner BG, Snydman DR, Freeman R, et al. Cytomegalovirus immune globulin for the prevention of primary CMV disease in renal transplant patients. Analysis of usage under treatment IND status. Transplant Proc 1993; 25: 1441–3PubMedGoogle Scholar
  119. 119.
    Balk AHMM, Weiman W, Rothbarth PH, et al. Passive immunization against cytomegalovirus in allograft recipients. The Rotterdam heart transplant experience. Infection 1993; 21: 195–200PubMedCrossRefGoogle Scholar
  120. 120.
    Tenschert W, Gonnermann D, Meyer-Moldenhauer WH, et al. Management of cytomegalovirus infection in high-risk recipients after renal transplantation: prophylaxis by hyperimmune globulins or DHPG treatment? Transplant Proc 1993; 25: 3256–8PubMedGoogle Scholar
  121. 121.
    Bailey TC, Ettinger NA, Storch GA, et al. Failure of high-dose oral acyclovir with or without globulin to prevent primary cytomegalovirus disease in recipients of solid organ transplants. Am J Med 1993; 95: 273–8PubMedCrossRefGoogle Scholar
  122. 122.
    Snydman DR, Werner BG, Dougherty NN, et al. A further analysis of the use of cytomegalovirus immune globulin in orthotopic liver transplant recipients at risk for primary infection. Transplant Proc 1994; 26: 23–7PubMedGoogle Scholar
  123. 123.
    Conti DJ, Freed BM, Gruber SA, et al. Prophylaxis of primarycytomegalovirus disease in renal transplant patients. Arch Surg 1994; 129: 443–7PubMedCrossRefGoogle Scholar
  124. 124.
    Zamora MR, Fullerton DN, Campbell et al. Use of cytomegalovirus (CMV) hyperimmune globulin for prevention of CMV disease in CMV-seropositive lung transplant recipients. Transplant Proc 1994; 26: 49–51PubMedGoogle Scholar
  125. 125.
    Basadonna G, Feria A, Perez R, et al. Incidence of infection and acute rejection after cytomegalovirus immune globulin prophylaxis in renal transplantation. Transplant Proc 1994; 26: 52–3PubMedGoogle Scholar
  126. 126.
    Prian GW, Koep LJ. Elimination of cytomegalovirus disease in liver transplant patients treated prophylactically with combination cytomegalovirus hyperimmune globulin and ganciclovir. Transplant Proc 1994; 26: 54–5PubMedGoogle Scholar
  127. 127.
    Nichol DL, MacDonald AS, Belitsky P, et al. Reduction by combination prophylactic therapy with CMV hyperimmune globulin and acyclovir of the risk of primary CMV disease in renal transplant recipients. Transplantation 1993; 55: 841–6CrossRefGoogle Scholar
  128. 128.
    Khawand N, Light JA, Brems W, et al. Does intravenous immunoglobulin prevent primary cytomegalovirus disease in kidney transplant recipients? Transplant Proc 1989; 21: 2072–4PubMedGoogle Scholar
  129. 129.
    Weimar W, Metselaar HJ, Balk AHMM, et al. Passive immunization to prevent cytomegalovirus disease after kidney and heart transplantation. Transplant Proc 1990; 22: 229–32PubMedGoogle Scholar
  130. 130.
    Gould FK, Freeman R, Taylor CE, et al. Prophylaxis and management of cytomegalovirus pneumonitis after lung transplantation: a review of experience in one center. J Heart Lung Transplant 1993; 12: 695–9PubMedGoogle Scholar
  131. 131.
    Dreikorn K, Doerr H-W, Guersen RG. Cytomegalovirus (CMV) infections in renal transplant recipients. Preliminary results of prophylaxis by an intramuscular hyperimmune CMV IgG. Scand J Urol Nephrol Suppl 1985; 92: 15–21PubMedGoogle Scholar
  132. 132.
    Havel MP, Laczkovics AM, Wolner E, et al. Prophylactic use of hyperimmunoglobulin for cytomegalovirus infection in heart transplantation. Clin Ther 1989; 11: 472–8PubMedGoogle Scholar
  133. 133.
    Steinmuller DR, Graneto D, Swift C, et al. Use of intravenous immunoglobulin prophylaxis for primary cytomegalovirus infection post living-related-donor renal transplantation. Transplant Proc 1989; 21: 2069–71PubMedGoogle Scholar
  134. 134.
    Tenschert W, Gonnermann D, Meyer-Moldenhauer W-H, et al. Management of cytomegalovirus infection in high-risk recipients after renal transplantation: prophylaxis by hyperimmunoglobulins or DHPG treatment? Transplant Proc 1993; 25: 3256–8PubMedGoogle Scholar
  135. 135.
    Metselaar HJ, Balk AHMM, Mochtar B, et al. Cytomegalovirus seronegative heart transplant recipients. Prophylactic use of anti-CMV immunoglobulin. Chest 1990; 97: 396–9PubMedCrossRefGoogle Scholar
  136. 136.
    Gorensek M, Carey WD, Vogt D, et al. A multivariate analysis of risk factors for cytomegalovirus infection in liver transplant recipients. Gastroenterology 1990; 98: 1326–32PubMedGoogle Scholar
  137. 137.
    Fassbinder W, Ernst W, Hanke P, et al. Cytomegalovirus infections after renal transplantation: effect of prophylactic hyperimmunoglobulin. Transplant Proc 1986; 18: 1393–6Google Scholar
  138. 138.
    Glowacki LS, Smaill FM. Use of immune globulin to prevent symptomatic cytomegalovirus disease in transplant recipients — a meta-analysis. Clin Transplant 1994; 8: 10–8PubMedGoogle Scholar
  139. 139.
    Cheeseman SH, Rubin RH, Stewart JA, et al. Controlled clinical trial of prophylactic human-leukocyte interferon in renal transplantation. N Engl J Med 1979; 300: 1345–9PubMedCrossRefGoogle Scholar
  140. 140.
    Hirsch MS, Schooley RT, Cosimii AB, et al. Effect of interferon-alpha on cytomegalovirus reactivation syndromes in renal transplant recipients. N Engl J Med 1983; 308: 1489–93PubMedCrossRefGoogle Scholar
  141. 141.
    Weimer W, Lameijer DF, Edy VG, et al. Prophylactic use of interferon in renal allograft recipients. Transplant Proc 1979; 11: 69–70Google Scholar
  142. 142.
    Kovariak J, Mayer G, Pohanka E, et al. Adverse effect of low-dose prophylactic human recombinant leukocyte interferon-alpha treatment in renal transplant recipients. Transplantation 1988; 45: 402–5CrossRefGoogle Scholar
  143. 143.
    Weimar W, Kramer P, Bijnen AB, et al. The incidence of cytomegalo- and herpes simplex virus infections in renal allograft recipients treated with high dose recombinant leukocyte interferon: a controlled trial. Scand J Urol Suppl 1985; 92: 37–9Google Scholar
  144. 144.
    Davis CL. The prevention of cytomegalovirus disease in renal transplantation. Am J Kidney Dis 1990; 16: 175–88PubMedGoogle Scholar
  145. 145.
    Lui SF, Ali AA, Grundy JE, et al. Double-blind, placebo-controlled trial of human lymphoblastoid interferon prophylaxis of cytomegalovirus infection in renal transplant recipients. Nephrol Dial Transplant 1992; 7: 1230–7PubMedGoogle Scholar
  146. 146.
    MacDonald AS, Belitsky P, Cohen A, et al. Cytomegalovirus disease prophylaxis in seronegative recipients of kidneys from seropositive donors by combination of cytomegalovirus-hyperimmune globulin and low-dose acyclovir. Transplant Proc 1991; 23: 1355–6PubMedGoogle Scholar
  147. 147.
    Vasquez EM, Sanchez J, Pollak R, et al. High-dose oral acyclovir prophylaxis for primary cytomegalovirus infection in seronegative allograft recipients. Transplantation 1993; 55: 448–50PubMedCrossRefGoogle Scholar
  148. 148.
    Legendre C, Ducloux D, Ferroni A, et al. Acyclovir in preventing cytomegalovirus infection in kidney transplant recipients: a case-controlled study. Transplant Proc 1993; 25: 1431–3PubMedGoogle Scholar
  149. 149.
    Wong T, Lavaud S, Toupance O, et al. Failure of acyclovir to prevent cytomegalovirus infection in renal allograft recipients. Transplant Proc 1993; 6: 285–9Google Scholar
  150. 150.
    Barton IK, Nicholson. Use of pooled immunoglobulin and acyclovir as prophylaxis against cytomegalovirus disease in recipients of renal allografts. Nephrol Dial Transplant 1991; 6: 524–6CrossRefGoogle Scholar
  151. 151.
    Elkhammas EA, Henry ML, Tesi RJ, et al. Cytomegalovirus prevention in combined kidney-pancreas transplantation using acyclovir alone. Transplant Proc 1994; 26: 436PubMedGoogle Scholar
  152. 152.
    Eisenmann D, Knipp H, Laube H, et al. Prevention of cytomegalovirus disease in heart transplant recipients by prophylaxis with cytomegalovirus hyperimmune globulin plus oral acyclovir. Transplant Proc 1990; 22: 2322–3PubMedGoogle Scholar
  153. 153.
    Mollison LC, Richards MJ, Johnson PDR, et al. High-dose oral acyclovir reduces the incidence of cytomegalovirus infection in liver transplant recipients. J Infect Dis 1993; 168: 721–4PubMedCrossRefGoogle Scholar
  154. 154.
    Kizilisik TA, Preiksaitis JK, Kneteman NM. Cytomegalovirus disease in liver transplant recipients: impact of acyclovir prophylaxis. Transplant Proc 1993; 25: 2282–3PubMedGoogle Scholar
  155. 155.
    Saliba F, Eyraud D, Samuel D, et al. Randomized controlled trial of acyclovir for the prevention of cytomegalovirus infection and disease in liver transplant recipients. Transplant Proc 1993; 25: 1444–5PubMedGoogle Scholar
  156. 156.
    Green M, Reyes J, Nour B, et al. Randomized trial of ganciclovir followed by high dose oral acyclovir vs ganciclovir alone in the prevention of cytomegalovirus disease in pediatric liver transplant recipients: preliminary analysis. Transplant Proc 1994; 26: 173–4PubMedGoogle Scholar
  157. 157.
    Elkins CC, Frist WH, Dummer S, et al. Cytomegalovirus disease after heart transplantation. Is acyclovir indicated. Ann Thorac Surg 1993; 56: 1267–73PubMedCrossRefGoogle Scholar
  158. 158.
    Balfour HH, Chace BA, Stapleton JT, et al. A randomized placebo-controlled trial of oral acyclovir for the prevention of cytomegalovirus disease in recipients of renal allografts. N Engl J Med 1989; 320: 1381–7PubMedCrossRefGoogle Scholar
  159. 159.
    Martin FM, Manez R, Linden P, et al. A prospective randomized trial comparing sequential ganciclovir—high dose acyclovir to high dose acyclovir for prevention of cytomegalovirus disease in adult liver transplant recipients. Transplantation 1994; 58: 779–85PubMedGoogle Scholar
  160. 160.
    Balfour HH, Fletcher CV, Dunn D. Prevention of cytomegalovirus disease with oral acyclovir. Transplant Proc 1991; 23: 17–9PubMedGoogle Scholar
  161. 161.
    Frey DJ, Matas AJ, Gillingham KJ, et al. Sequential therapy — a prospective randomized trial of MALG versus OKT3 for prophylactic immunosuppression in cadaver renal allograft recipients. Transplantation 1992; 54: 50–6PubMedCrossRefGoogle Scholar
  162. 162.
    Boivin G, Erice A, Crane DD, et al. Acyclovir susceptibilities of herpes simplex virus strains isolated from solid organ transplant recipients after acyclovir or ganciclovir prophylaxis. Antimicrob Agents Chemother 1993; 37: 357–9PubMedCrossRefGoogle Scholar
  163. 163.
    Rondeau E, Bourgeon B, Peraldi MN, et al. Effect of prophylactic ganciclovir on cytomegalovirus infection in renal transplant recipients. Nephrol Dial Transplant 1993; 8: 858–62PubMedGoogle Scholar
  164. 164.
    Dunn DL, Gillingham KJ, Kramer MA, et al. A prospective randomized study of acyclovir versus ganciclovir plus human immune globulin prophylaxis of cytomegalovirus infection after solid organ transplantation. Transplantation 1994; 57: 876–84PubMedCrossRefGoogle Scholar
  165. 165.
    Duncan SR, Grgurich WF, Iaceno AT, et al. A comparison of ganciclovir and acyclovir to prevent cytomegalovirus after lung transplantation. Am J Respir Crit Care Med 1994; 150: 146–52PubMedGoogle Scholar
  166. 166.
    Nakazato PZ, Burns W, Moore P, et al. Viral prophylaxis in hepatic transplantation: preliminary report of a randomized trial of acyclovir and ganciclovir. Transplant Proc 1993; 25: 1935–7PubMedGoogle Scholar
  167. 167.
    Bailey TC, Trulock EP, Ettinger NA, et al. Failure of prophylactic ganciclovir to prevent cytomegalovirus disease in recipients of lung transplants. J Infect Dis 1992; 165: 48–52CrossRefGoogle Scholar
  168. 168.
    Portela D, Patel R, Keating MR, et al. A randomized controlled trial evaluating ganciclovir followed by high dose acyclovir versus acyclovir in the prophylaxis of cytomegalovirus infection in liver transplantation [abstract]. Second Congress of the International Liver Transplantation Society, Toronto, Canada, 1993Google Scholar
  169. 169.
    Cohen AT, O’Grady JG, Sutherland S, et al. Controlled trial of prophylactic versus therapeutic use of ganciclovir in liver transplantation in adults. J Med Virol 1993; 40: 5–9PubMedCrossRefGoogle Scholar
  170. 170.
    Merigan TC, Renlund DG, Keay S, et al. A controlled trial of ganciclovir to prevent cytomegalovirus disease after heart transplantation. N Engl J Med 1992; 326: 1182–6PubMedCrossRefGoogle Scholar
  171. 171.
    Laske A, Gallino A, Mohacsi P, et al. Prophylactic treatment with ganciclovir for cytomegalovirus infection in heart transplantation. Transplant Proc 1991; 23: 1170–3PubMedGoogle Scholar
  172. 172.
    Duncan SR, Paradis IL, Dauber JH, et al. Ganciclovir prophylaxis for cytomegalovirus infections in pulmonary allograft recipients. Rev Respir Dis 1992; 146: 1213–5Google Scholar
  173. 173.
    Freise CE, Pons V, Lake J, et al. Comparison of three regimens for cytomegalovirus prophylaxis in 147 liver transplant recipients. Transplant Proc 1991; 23: 1498–500PubMedGoogle Scholar
  174. 174.
    Winston DJ, Wirin D, Shaked A, et al. Randomised comparison of ganciclovir and high-dose acyclovir for long-term cytomegalovirus prophylaxis in liver-transplant recipients. Lancet 1995; 346: 69–74PubMedCrossRefGoogle Scholar
  175. 175.
    Aguado JM, Gomez-Sanchez MA, Lumbreras C, et al. Prospective randomized trial of efficacy of ganciclovir versus that of anti-cytomegalovirus (CMV) immunoglobulin to prevent CMV disease in CMV-seropositive heart transplant recipients treated with OKT3. Antimicrob Agents Chemother 1995; 39: 1643–5PubMedCrossRefGoogle Scholar
  176. 176.
    Maurer JR, Snell G, de Hoyos A, et al. Outcomes of lung transplantation using three different cytomegalovirus prophylactic regimens. Transplant Proc 1993; 25: 1434–5PubMedGoogle Scholar
  177. 177.
    Stratta RJ, Taylor RJ, Byron TJ. Viral prophylaxis in combined pancreas-kidney transplant patients. Transplantation 1994; 57: 506–12PubMedGoogle Scholar
  178. 178.
    Harland RC, Vernon WB, Bunzendahl H, et al. Ganciclovir/acyclovir prophylaxis reduces the incidence of cytomegalovirus infections in pancreas transplant recipients. Transplant Proc 1994; 26: 432–3PubMedGoogle Scholar
  179. 179.
    Spector SA, McKinley G, Drew WL, et al. A randomized, double-blind study of the efficacy and safety of oral ganciclovir for the prevention of cytomegalovirus disease in HIV-infected persons [abstract]. Proc ICAAC 34th; Orlando FL; 1994Google Scholar
  180. 180.
    Bailey TC. Prevention of cytomegalovirus disease. Sem Respir Infect 1993; 8: 225–32Google Scholar
  181. 181.
    Rubin RH, Tolkoff-Rubin NE. Antimicrobial strategies in the care of organ transplant recipients. Antimicrob Agents Chemother 1993; 37: 619–24PubMedCrossRefGoogle Scholar
  182. 182.
    Singh N, Yu VL, Mietes L, et al. High-dose acyclovir compared with short-course preemptive therapy to prevent cytomegalovirus disease in liver transplant recipients. A randomized trial. Ann Intern Med 1994; 120: 375–81PubMedGoogle Scholar
  183. 183.
    Cagle PT, Buttone G, Holland VA, et al. Semiquantitative measurement of cytomegalovirus DNA in lung and heart-lung transplant patients by in vitro DNA amplification. Chest 1992; 101: 93–6PubMedCrossRefGoogle Scholar
  184. 184.
    Patel R, Smith TF, Espy M, et al. Detection of cytomegalovirus DNA in sera of liver transplant recipients. J Clin Microbiol 1994; 32: 1431–4PubMedGoogle Scholar
  185. 185.
    Iberer F, Halwachs-Baumann G, Rodi S, et al. Monitoring cytomegalovirus disease after heart transplantation. Persistence of anti-cytomegalovirus IgM antibodies. J Heart Lung Transplant 1994; 13: 405–11PubMedGoogle Scholar
  186. 186.
    Portela D, Patel R, Larson-Keller JJ, et al. OKT3 treatment for allograft rejection is a risk factor for CMV disease in liver transplantation. J Infect Dis. In pressGoogle Scholar
  187. 187.
    Hibberd PL, Tolkoff-Rubin NE, Cosimi AB, et al. Symptomatic cytomegalovirus disease in the cytomegalovirus antibody seropositive renal transplant recipient treated with OKT3. Transplantation 1992; 53: 68–72PubMedCrossRefGoogle Scholar
  188. 188.
    Prokurats S, Drabik E, Genda R, et al. Ganciclovir in cytomegalovirus prophylaxis in high-risk pediatric renal transplant patients. Transplant Proc 1993; 25: 2577Google Scholar
  189. 189.
    So S, Mayo C, McCullough C, et al. Cytomegalovirus prophylaxis in pediatric renal transplant recipients. Transplant Proc 1993; 25: 1414–5PubMedGoogle Scholar
  190. 190.
    Lumbreras C, Otero JR, Herrero JA, et al. Ganciclovir prophylaxis decreases frequency and severity of cytomegalovirus disease in seropositive liver transplant recipients treated with OKT3 monoclonal antibodies. Antimicrob Agents Chemother 1993; 37: 2490–2PubMedCrossRefGoogle Scholar
  191. 191.
    Hopt UT, Pfeffer F, Schareck W, et al. Ganciclovir for prophylaxis of CMV disease after pancreas/kidney transplantation. Transplant Proc 1994; 26: 434–5PubMedGoogle Scholar
  192. 192.
    Hibberd PL, Tolkoff-Rubin NE, Conti D, et al. Preemptive ganciclovir therapy to prevent cytomegalovirus disease in cytomegalovirus antibody-positive renal transplant recipients. A randomized controlled trial. Ann Intern Med 1995; 123: 18–26PubMedGoogle Scholar
  193. 193.
    Metselaar HJ, Rothbarth PH, Brouwer RM, et al. Prevention of cytomegalovirus-related death by passive immunization. A double-blind placebo-controlled study in kidney transplant recipients treated for rejection. Transplantation 1989; 48: 264–6PubMedCrossRefGoogle Scholar
  194. 194.
    Steinmuller DR, Novick AC, Streen SB, et al. Intravenous immunoglobulin infusions for the prophylaxis of secondary cytomegalovirus infection. Transplantation 1990; 49: 68–70PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 1996

Authors and Affiliations

  • Robin Patel
    • 1
  • Russell H. Wiesner
    • 2
  • Carlos V. Paya
    • 1
  1. 1.Division of Infectious DiseasesMayo ClinicRochesterUSA
  2. 2.Department of TransplantationMayo ClinicRochesterUSA

Personalised recommendations