, Volume 13, Issue 3, pp 159–175

Current Management Strategies for the Treatment and Prevention of Cytomegalovirus Infection in Solid Organ Transplant Recipients

Disease Management


Cytomegalovirus (CMV) infection in solid organ transplantation is associated with significant morbidity and mortality. Primary infection, secondary infection or superinfection may occur in this setting. Progression to disease may ensue with development of symptoms, with or without organ involvement. The mainstay of treatment of CMV disease is intravenous ganciclovir. Aside from protective organ matching and use of CMV-seronegative blood products, methods of preventing CMV infection and disease include passive immunisation with immunoglobulins, vaccination, and prophylaxis with antiviral agents such as aciclovir, oral or intravenous ganciclovir, and oral valaciclovir. A promising subunit vaccine is currently being investigated. Pre-emptive therapy is a form of prevention that is based either on the early detection of CMV or targeting of transplant recipients with risk factors for CMV. New sensitive laboratory assays, including the pp65 anti-genaemia assay, qualitative, quantitative and reverse-transcription polymerase chain reaction assays, hybridisation assays, and nucleic acid sequence-based assays, have the ability to detect early CMV replication before disease becomes evident. These assays are being used as prospective surveillance tests, with pre-emptive therapy initiated when they become positive or demonstrate an increasing titre.


  1. 1.
    Rice GP, Schrier RD, Oldstone MB, et al. Cytomegalovirus infects human lymphocytes and monocytes: virus expression is restricted to immediate-early gene products. Proc Natl Acad Sci U S A 1984; 81(19): 6134–8CrossRefPubMedGoogle Scholar
  2. 2.
    Taylor-Wiedeman J, Sissons JG, Borysiewicz LK, et al. Monocytes are a major site of persistence of human cytomegalovirus in peripheral blood mononuclear cells. J Gen Virol 1991; 72 (Pt 9): 2059–64CrossRefPubMedGoogle Scholar
  3. 3.
    Soderberg C, Larsson S, Bergstedt-Lindqvist, et al. Definition of a subset of human peripheral blood mononuclear cells that are permissive to human cytomegalovirus infection. J Virol 1993; 67: 3166–75PubMedGoogle Scholar
  4. 4.
    Fiala M, Payne JE, Berne TV, et al. Epidemiology of cytomegalovirus infections after transplantation and immunosuppression. J Infect Dis 1975; 132(4): 421–33CrossRefPubMedGoogle Scholar
  5. 5.
    Wentworth BB, Alexander ER. Seroepidemiology of infections due to members of the herpesvirus group. Am J Epidemiol 1971; 94(5): 496–507PubMedGoogle Scholar
  6. 6.
    Apperley JF, Goldman JM. Cytomegalovirus: biology, clinical features and methods for diagnosis. Bone Marrow Transplant 1988; 3(4): 253–64PubMedGoogle Scholar
  7. 7.
    Lam KMC, Khan M. Cytomegalovirus in transplantation: new developments. Coron Artery Dis 1997; 8: 305–16CrossRefPubMedGoogle Scholar
  8. 8.
    Betts RF, Freeman RB, Douglas Jr RG, et al. Transmission of cytomegalovirus infection with renal allograft. K Int 1975; 8(6): 385–92CrossRefGoogle Scholar
  9. 9.
    Kuypers Dirk RJ, Vanrenterghem Y. Prophylaxis of cytomegalovirus infection in renal transplantation. Nephrol Dial Transplant 1998; 13: 3012–6CrossRefPubMedGoogle Scholar
  10. 10.
    Patel R, Paya CV. Infections in solid-organ transplant recipients. Clin Microbiol Rev 1997; 10(1): 86–124PubMedGoogle Scholar
  11. 11.
    Chou S. Acquisition of donor strains of cytomegalovirus by renal-transplant recipients. NEngl J Med 1986; 314: 1418–23CrossRefGoogle Scholar
  12. 12.
    Chou S. Cytomegalovirus infection and reinfection transmitted by heart transplantation. J Infect Dis 1987; 155: 1054–6CrossRefPubMedGoogle Scholar
  13. 13.
    Grundy JE, Lui SF, Super M, et al. Symptomatic cytomegalovirus infection in seropositive kidney recipients: reinfection with donor virus rather than reactivation of recipient virus. Lancet 1988; 2(8603): 132–5CrossRefPubMedGoogle Scholar
  14. 14.
    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: 68–72CrossRefPubMedGoogle Scholar
  15. 15.
    Bailey TC, Powderly WG, Storch GA. Symptomatic cytomegalovirus infection in renal transplant recipients given either Minnesota antilymphoblast globulin (MALG) or OKT3 for rejection prophylaxis. Am J Kidney Dis 1993; 21(2): 196–201PubMedGoogle Scholar
  16. 16.
    Portela D, Patel R, Larson-Keller J, et al. OKT3 treatment for allograft rejection is a risk factor for cytomegalovirus disease in liver transplantation. J Infect Dis 1995; 171: 1014–8CrossRefPubMedGoogle Scholar
  17. 17.
    Kahan BD, Chobrial R. Immunosuppressive agents. Surg Clin North Am 1994; 74(5): 1029–54PubMedGoogle Scholar
  18. 18.
    The Tricontinental Mycophenolate Mofetil Renal Transplantation Study Group. A blinded, randomized clinical trial of mycophenolate mofetil for the prevention of acute rejection in cadaveric renal transplantation. Transplantation 1996; 61: 1029–37CrossRefGoogle Scholar
  19. 19.
    Paterson DL, Stapelfeldt WH, Wagener MM, et al. Intraoperative hypothermia is an independent risk factor for early cytomegalovirus infection in liver transplant recipients. Transplantation 1999; 67(8): 1151–5CrossRefPubMedGoogle Scholar
  20. 20.
    Paya CV, Wiesner RH, Herman PE, et al. Risk factors for cytomegalovirus and severe bacterial infections following liver transplantation: a prospective multivariate time-dependent analysis. J Hepatol 1993; 18: 185–95CrossRefPubMedGoogle Scholar
  21. 21.
    Stratta RJ, Shaeffer MS, Markin RS, et al. Cytomegalovirus infection and disease after liver transplantation. An overview. Dig Dis Sci 1992; 37(5): 673–88CrossRefPubMedGoogle Scholar
  22. 22.
    Mutimer DJ, Shaw J, ODK Elias E. Enhanced (cytomegalovirus) viral replication after transplantation for fulminant hepatic failure. Liver Transplant Surg 1997; 3(5): 506–12CrossRefGoogle Scholar
  23. 23.
    DesJardin JA, Gibbons L, Cho E, et al. Human herpesvirus 6 reactivation is associated with cytomegalovirus infection and syndromes in kidney transplant recipients at risk for primary cytomegalovirus infection. J Infect Dis 1998; 178(6): 1783–6CrossRefPubMedGoogle Scholar
  24. 24.
    Ratnamohan VM, Chapman J, Howse H, et al. Cytomegalovirus and human herpesvirus 6 both cause viral disease after renal transplantation. Transplantation 1998; 66(7): 877–82CrossRefPubMedGoogle Scholar
  25. 25.
    Humar A, Uknis M, Carlone-Jambor C, et al. Cytomegalovirus disease recurrence after ganciclovir treatment in kidney and kidney-pancreas transplant recipients. Transplantation 1999; 67(1): 94–7CrossRefPubMedGoogle Scholar
  26. 26.
    Rytel MW, Balay J. Cytomegalovirus infection and immunity in renal allograft recipients: assessment of the competence of humoral immunity. Infect Immunol 1976; 13(6): 1633–7Google Scholar
  27. 27.
    Rook A. Interactions of cytomegalovirus with the human immune system. Rev Infect Dis 1988; 10Suppl. 3: S460–7CrossRefPubMedGoogle Scholar
  28. 28.
    Rubin RH. Infection in the organ transplant recipient. In: Rubin RH, Young LS, editors. Clinical approach to infection in the compromised host. 3rd ed. New York: Plenum Medical Book Co., 1994: 629–705CrossRefGoogle Scholar
  29. 29.
    Rand KH, Pollard RB, Merigan TC. Increased pulmonary super-infections in cardiac-transplant patients undergoing primary cytomegalovirus infection. N Engl J Med 1978; 298(17): 951–3CrossRefPubMedGoogle Scholar
  30. 30.
    Chatterjee SN, Fiala M, Weiner J, et al. Primary cytomegalovirus and opportunistic infections. Incidence in renal transplant recipients. JAMA 1978; 240(22): 2446–9CrossRefPubMedGoogle Scholar
  31. 31.
    Husni RN, Gordon SM, Longworth DL, et al. Cytomegalovirus infection is a risk factor for invasive aspergillosis in lung transplant recipients. Clin Infect Dis 1998; 26(3): 753–5CrossRefPubMedGoogle Scholar
  32. 32.
    Falagas ME, Snydman DR, Griffith J, et al. Exposure to cytomegalovirus from the donated organ is a risk factor for bac-teremia in orthotopic liver transplant recipients. Clin Infect Dis 1996; 23(3): 468–74CrossRefPubMedGoogle Scholar
  33. 33.
    Linneman Jr CC, Kauffman CA, First MR, et al. Cellular immune response to cytomegalovirus infection after renal transplantation. Infect Immunol 1978; 22(1): 176–80Google Scholar
  34. 34.
    Carney WP, Rubin RH, Hoffman RA, et al. Analysis of T lymphocyte subsets in cytomegalovirus mononucleosis. J Immunol 1981; 126(6): 2114–6PubMedGoogle Scholar
  35. 35.
    Doody DP, Wilson EJ, Medearis DN, et al. Changes in the phenotype of T-cell subset determinants following murine cytomegalovirus infection. Clin Immunol Immunopathol 1986; 40: 466–75CrossRefPubMedGoogle Scholar
  36. 36.
    Schooley RT, Hirsch MS, Colvin RB, et al. Association of herpesvirus infections with T-lymphocyte-subset alterations, glomerulopathy, and opportunistic infections after renal transplantation. N Engl J Med 1983; 308(6): 307–13CrossRefPubMedGoogle Scholar
  37. 37.
    Schrier RD, Rice GP, Oldstone MB. Suppression of natural killer cell activity and T cell proliferation by fresh isolates of human cytomegalovirus. J Infect Dis 1986; 153(6): 1084–91CrossRefPubMedGoogle Scholar
  38. 38.
    Rubin RH, Tolkoff-Rubin NE. Antimicrobial strategies in the care of organ transplant recipients. Antimicrob Agents Chemother 1993; 37: 619–24CrossRefPubMedGoogle Scholar
  39. 39.
    Basgoz N, Preiksaitis JK. Post-transplant lymphoproliferative disorder. Infect Dis Clin North Am 1995; 9: 901–23PubMedGoogle Scholar
  40. 40.
    Reinke P, Fietze E, Ode-Hakim S, et al. Late-acute renal allograft rejection and symptomless cytomegalovirus infection. Lancet 1994; 344: 1737–8CrossRefPubMedGoogle Scholar
  41. 41.
    Bertoni E, Rosati A, Zanazzi M, et al. Cytomegalovirus disease prophylaxis in renal transplantation by high dose oral acyclovir: efficacy and limits. Transplant Proc 1998; 30: 2094CrossRefPubMedGoogle Scholar
  42. 42.
    Grattan MT, Moreno-Cabral CE, Starnes VA, et al. Cytomegalovirus infection is associated with cardiac allograft rejection and atherosclerosis. JAMA 1989; 261: 3561–6CrossRefPubMedGoogle Scholar
  43. 43.
    Normann SJ, Salomon DR, Leelachaikul P, et al. Acute vascular rejection of the coronary arteries in human heart transplantation: pathology and correlations with immunosuppression and cytomegalovirus infection. J Heart Lung Transplant 1991; 10 (5 Pt 1): 674–87PubMedGoogle Scholar
  44. 44.
    Scott JP, Higenbottam TW, Sharpies L, et al. Risk factors for obliterative bronchiolitis in heart-lung transplant recipients. Transplantation 1991; 51(4): 813–7CrossRefPubMedGoogle Scholar
  45. 45.
    Bando K, Paradis IL, Similo S, et al. Obliterative bronchiolitis after lung and heart-lung transplantation. An analysis of risk factors and management. J Thoracic Cardiovasc Surg 1995; 110(1): 4–14CrossRefGoogle Scholar
  46. 46.
    Reichenspurner H, Girgis RE, Robbins RC, et al. Obliterative bronchiolitis after lung and heart-lung transplantation. Ann Thorac Surg 1995; 60(6): 1845–53CrossRefPubMedGoogle Scholar
  47. 47.
    Keenan RJ, Lea ME, Dummer JS, et al. Cytomegalovirus serologic status and postoperative infection correlated with risk of developing chronic rejection after pulmonary transplantation. Transplantation 1991; 51(2): 433–8CrossRefPubMedGoogle Scholar
  48. 48.
    Duncan SR, Paradis IL, Yousem SA, et al. Sequelae of cytomegalovirus pulmonary infections in lung allograft recipients. Am Rev Respir Dis 1992; 146(6): 1419–4PubMedGoogle Scholar
  49. 49.
    Speich R, Thurnheer R, Gaspert A, et al. Efficacy and cost effectiveness of oral ganciclovir in the prevention of cytomegalovirus disease after lung transplantation. Transplantation 1999; 67(2): 315–20CrossRefPubMedGoogle Scholar
  50. 50.
    O’Grady JG, Sutherland S, Harvey F, et al. Cytomegalovirus infection and donor/recipients HLA antigens: interdependent co-factors in pathogenesis of vanishing bile duct syndrome after liver transplantation. Lancet 1988; 2: 302–5CrossRefPubMedGoogle Scholar
  51. 51.
    Paya CV, Wiesner RH, Hermans PE, et al. Lack of association between cytomegalovirus infection, HLA matching and the vanishing bile duct syndrome after liver transplantation. Hepatology 1992; 16(1): 66–70CrossRefPubMedGoogle Scholar
  52. 52.
    Wright TL. Cytomegalovirus infection and vanishing bile duct syndrome: culprit or innocent bystander? Hepatology 1992; 16(2): 494–6CrossRefPubMedGoogle Scholar
  53. 53.
    Lautenschlager I, Hockerstedt K, Jalanko H, et al. Persistent cytomegalovirus in liver allografts with chronic rejection. Hepatology 1997; 25(1): 190–4CrossRefPubMedGoogle Scholar
  54. 54.
    Madalosso C, de Souza Jr NF, Ilstrup DM, et al. Cytomegalovirus and its association with hepatic artery thrombosis after liver transplantation. Transplantation 1998; 66(3): 294–7CrossRefPubMedGoogle Scholar
  55. 55.
    Pouria S, State OI, Wong W, et al. CMV infection is associated with transplant renal artery stenosis. Quart J Med 1998; 91(3): 185–9CrossRefGoogle Scholar
  56. 56.
    Falagas ME, Snydman DR, Griffith J, et al. Effect of cytomegalovirus infection status on first-year mortality rates among orthotopic liver transplant recipients. The Boston Center for liver transplantation CMVIG study group. Ann Int Med 1997; 126(4): 275–9PubMedGoogle Scholar
  57. 57.
    de Otero J, Gavalda J, Murio E, et al. Cytomegalovirus disease as a risk factor for graft loss and death after orthotopic liver transplantation. Clin Infect Dis 1998; 26(4): 865–70CrossRefPubMedGoogle Scholar
  58. 58.
    Koskinen P, Lemstrom K, Mattila S, et al. Cytomegalovirus infection associated accelerated heart allograft arteriosclerosis may impair the late function of the graft. Clin Transplant 1996; 10 (6 Pt 1): 487–93PubMedGoogle Scholar
  59. 59.
    Peterson PK, Balfour Jr HH, Marker SC, et al. Cytomegalovirus disease in renal allograft recipients: a prospective study of the clinical features, risk factors and impact on renal transplantation. Medicine 1980; 59(4): 283–300CrossRefPubMedGoogle Scholar
  60. 60.
    Patel R, Paya CV. Cytomegalovirus infection and disease in solid organ transplant recipients. In: Bowden RA, Ljungman P, Paya CV, editors. Transplant Infections. Lippincott-Raven publishers, 1998: 229-44Google Scholar
  61. 61.
    Einsele H, Waller HD, Weber P, et al. Cytomegalovirus in liver biopsies of marrow transplant recipients: detection methods, clinical, histological and immunohistological features. Med Microbiol Immunol 1994; 183(4): 205–16CrossRefPubMedGoogle Scholar
  62. 62.
    Sibley RK, Berry GJ, Tazelaar HD, et al. The role of trans-bronchial biopsies in the management of lung transplant recipients. J Heart Lung Transplant 1993; 12: 308–24PubMedGoogle Scholar
  63. 63.
    Yousem SA, Berry GJ, Cagle PT, et al. Revision of the 1990 working formulation for the classification off pulmonary allograft rejection: lung rejection study group. J Heart Lung Transplant 1996; 15: 1–15PubMedGoogle Scholar
  64. 64.
    Rubin RH. Prevention of infection in the liver transplant recipient. Liver Transplant Surg 1996; 2(5) Suppl 1: 89–98Google Scholar
  65. 65.
    Singh N, Zeevi A, Gayowski T, et al. Late onset cytomegalovirus disease in liver transplant recipients: de novo reactivation in recurrent hepatitis C virus hepatitis. Transplant Int 1998; 11(4): 308–11CrossRefGoogle Scholar
  66. 66.
    van den Berg AP, Klompmaker IJ, Haagsma EB, et al. Monitoring antigenemia is useful in guiding treatment of severe cytomegalovirus disease after organ transplantation. Transplant Int 1992; 5(2): 101–6CrossRefGoogle Scholar
  67. 67.
    Gerna G, Zipeto D, Parea M, et al. Monitoring of human cytomegalovirus infections and ganciclovir treatment in heart transplant recipients by determination of viremia, antigenemia, and DNAemia. J Infect Dis 1991; 164(3): 488–98CrossRefPubMedGoogle Scholar
  68. 68.
    Boeckh M, Bowden RA, Goodrich JM, et al. Cytomegalovirus antigen detection in peripheral blood leukocytes after allogeneic marrow transplantation. Blood 1992; 80(5): 1358–64PubMedGoogle Scholar
  69. 69.
    Gerna G, Revello MG, Percivalle E, et al. Comparison of different immunostaining techniques and monoclonal antibodies to the lower matrix phosphoprotein (pp65) for optimal quantitation of human cytomegalovirus antigenemia. J Clin Microbiol 1992; 30(5): 1232–7PubMedGoogle Scholar
  70. 70.
    Jiwa NM, van Gemert GW, Rupp AK, et al. Rapid detection of human cytomegalovirus DNA in peripheral blood leukocytes of viremic transplant recipients by the polymerase chain reaction. Transplantation 1989; 48(1): 72–6CrossRefPubMedGoogle Scholar
  71. 71.
    Benedetti E, Mihalov M, Asolati M, et al. A prospective study of the predictive value of polymerase chain reaction assay for cytomegalovirus in asymptomatic kidney transplant recipients. Clin Transplant 1998; 12: 391–5PubMedGoogle Scholar
  72. 72.
    Patel R, Smith TF, Espy MJ, et al. A prospective comparison of molecular diagnostic techniques for the early detection of cytomegalovirus in liver transplant recipients. J Infect Dis 1995; 171: 1010–4CrossRefPubMedGoogle Scholar
  73. 73.
    Bitsch A, Kirchner H, Dupke R, et al. Cytomegalovirus transcripts in peripheral blood leukocytes of actively infected transplant patients detected by reverse transcription-polymer-ase chain reaction. J Infect Dis 1993; 167(3): 740–3CrossRefPubMedGoogle Scholar
  74. 74.
    Zhang LJ, Hanff P, Rutherford C, et al. Detection of human cytomegalovirus DNA, RNA and antibody in normal donor blood. J Infect Dis 1995; 171(4): 1002–6CrossRefPubMedGoogle Scholar
  75. 75.
    Meyer-Konig U, Serr A, von Laer D, et al. Human cytomegalovirus immediate early and late transcripts in peripheral blood leukocytes: diagnostic value in renal transplant recipients. J Infect Dis 1995; 171(3): 705–9CrossRefPubMedGoogle Scholar
  76. 76.
    Mazzulli T, Wood S, Chua R, et al. Evaluation of the digene hybrid capture system for detection and quantitation of human cytomegalovirus viremia in human immunodeficiency virus-infected patients. J Clin Microbiol 1996; 34(12): 2959–62PubMedGoogle Scholar
  77. 77.
    Blok MJ, Goossens VJ, Vanherle SJ, et al. Diagnostic value of monitoring human cytomegalovirus late pp67 mRNA expression in renal-allograft recipients by nucleic acid sequence-based amplification. J Clin Microbiol 1998; 36(5): 1341–6PubMedGoogle Scholar
  78. 78.
    Kidd IM, Fox JC, Pillay D, et al. Provision of prognostic information in immunocompromised patients by routine application of the polymerase chain reaction for cytomegalovirus. Transplantation 1993; 56(4): 867–71CrossRefPubMedGoogle Scholar
  79. 79.
    Eriksson BM, Wirgart BZ, Claesson K, et al. A prospective study of rapid methods of detecting cytomegalovirus in the blood of renal transplant recipients in relation to patient and graft survival. Clin Transplant 1996; 10 (6 Pt 1): 494–502PubMedGoogle Scholar
  80. 80.
    Gerna G, Furione M, Baldanti F, et al. Comparative quantitation of human cytomegalovirus DNA in blood leukocytes and plasma of transplant and AIDS patients. J Clin Microbiol 1994; 32(11): 2709–17PubMedGoogle Scholar
  81. 81.
    Hamprecht KJ, Steinmassl M, Einsele H, et al. Discordant detection of human cytomegalovirus DNA from peripheral blood mononuclear cells, granulocytes and plasma-Correlation to viremia and HCMV infection. J Clin Virol 1998; 11(2): 125–36CrossRefPubMedGoogle Scholar
  82. 82.
    Cope AV, Sweny P, Sabin C, et al. Quantity of cytomegalovirus viruria is a major risk factor for cytomegalovirus disease after renal transplantation. J Med Virol 1997; 52 (2): 200–5CrossRefPubMedGoogle Scholar
  83. 83.
    Kotsimbos AT, Sinickas V, Glare EM, et al. Quantitative detection of human cytomegalovirus DNA in lung transplant recipients. Am J Respir Crit Care Med 1997; 156 (4 Pt 1): 1241–6PubMedGoogle Scholar
  84. 84.
    Stephan F, Fajac A, Grenet D, et al. Predictive value of cytomegalovirus DNA detection by polymerase chain reaction in blood and bronchoalveolar lavage in lung transplant patients. Transplantation 1997; 63(10): 1430–5CrossRefPubMedGoogle Scholar
  85. 85.
    Cinque P, Vago L, Brytting M, et al. Cytomegalovirus infection of the central nervous system in patients with AIDS: diagnosis by DNA amplification from cerebrospinal fluid. J Infect Dis 1992; 166(6): 1408–11CrossRefPubMedGoogle Scholar
  86. 86.
    Weinberg A, Spiers D, Cai GY, et al. Evaluation of a commercial PCR kit for diagnosis of cytomegalovirus infection of the central nervous system. J Clin Microbiol 1998; 36(11): 3382–4PubMedGoogle Scholar
  87. 87.
    Wolf DG, Spector SA. Diagnosis of human cytomegalovirus central nervous system disease in AIDS patients by DNA amplification from cerebrospinal fluid. J Infect Dis 1992; 166(6): 1412–5CrossRefPubMedGoogle Scholar
  88. 88.
    Burgart LJ, Heller MJ, Reznicek MJ, et al. Cytomegalovirus detection in bone marrow transplant patients with idiopathic pneumonitis. A clinicopathologic study of the clinical utility of the polymerase chain reaction on open lung biopsy specimen tissue. Am J Clin Pathol 1991; 96(5): 572–6PubMedGoogle Scholar
  89. 89.
    Brainard JA, Greenson JK, Vesy CJ, et al. Detection of cytomegalovirus in liver transplant biopsies, A comparison of light microscopy, immunohistochemistry, duplex PCR and nested PCR. Transplantation 1994; 57(12): 1753–7PubMedGoogle Scholar
  90. 90.
    Wolff MA, Rand KH, Houck HJ, et al. Relationship of the polymerase chain reaction for cytomegalovirus to the development of hepatitis in liver transplant recipients. Transplantation 1993; 56(3): 572–6CrossRefPubMedGoogle Scholar
  91. 91.
    Loning T, Stilo K, Riviere A, et al. Cytomegalovirus detection in kidney transplants: results obtained from the polymerase chain reaction. Clin Nephrol 1992; 37(2): 78–83PubMedGoogle Scholar
  92. 92.
    Mitchell SM, Fox JD, Tedder RS, et al. Vitreous fluid sampling and viral genome detection for the diagnosis of viral retintis in patients with AIDS. J Med Virol 1994; 43(4): 336–40CrossRefPubMedGoogle Scholar
  93. 93.
    Toyoda M, Carlos JB, Galera OA, et al. Correlation of cytomegalovirus DNA levels with response to antiviral therapy in cardiac and renal allograft recipients. Transplantation 1997; 63(7): 957–63CrossRefPubMedGoogle Scholar
  94. 94.
    Zipeto D, Baldanti F, Zella D, et al. Quantification of human cytomgalovirus DNA in peripheral blood polymorphonuclear leukocytes of immunocompromised patients by the polymerase chain reaction. J Virol Meth 1993; 44(1): 45–55CrossRefGoogle Scholar
  95. 95.
    Hiyoshi M, Tagawa S, Takubo T, et al. Evaluation of the AMPLICOR CMV test for direct detection of cytomegalovirus in plasma specimens. J Clin Microbiol 1997; 35(10): 2692–4PubMedGoogle Scholar
  96. 96.
    Blok MJ, Christisans MH, Goossens VJ, et al. Evaluation of a new method for Early dectection of active cytomegalovirus infections. Transpl Int 1998; 11 (1 Suppl.): 107S–9SGoogle Scholar
  97. 97.
    Patel R, Snydman DR, Rubin, et al. Cytomegalovirus prophylaxis in solid organ transplant recipients. Transplantation 1996; 61(9): 1279–89CrossRefPubMedGoogle Scholar
  98. 98.
    Falagas ME, Snydman DR, Ruthazer R, et al. Surveillance cultures of blood, urine and throat specimens are not valuable for predicting cytomegalovirus disease in liver transplant recipients. Boston Center for liver transplant CMV Immune Globulin Study Group. Clin Infect Dis 1997; 24(5): 824–9CrossRefPubMedGoogle Scholar
  99. 99.
    Murray BM, Amsterdam D, Gray V, et al. Monitoring and diagnosis of cytomegalovirus infection in renal transplantation. J Am Soc Neph 1997; 8(9): 1448–57Google Scholar
  100. 100.
    Tong CYW, Cuevas L, Williams H, et al. Use of laboratory assays to predict cytomegalovirus disease in renal transplant recipients. J Clin Microbiol 1998; 36: 2681–5PubMedGoogle Scholar
  101. 101.
    Tanabe K, Tokumoto T, Ishikawa N, et al. Comparative study of cytomegalovirus (CMV) antigenemia assay, polymerase chain reaction, serology, and shell vial assay in the early diagnosis and monitoring of CMV infection after renal transplantation. Transplantation 1997; 64: 1721–5CrossRefPubMedGoogle Scholar
  102. 102.
    Bossart W, Bienz K, Wunderli W. Surveillance of cytomegalovirus after solid-organ transplantation: comparison of pp65 antigenemia assay with a quantitative hybridization assay. J Clin Microbiol 1997; 35(12): 3303–4PubMedGoogle Scholar
  103. 103.
    Randhawa PS, Manez R, Frye B, et al. Circulating immediateearly mRNA in patients with cytomegalovirus infections after solid organ transplantation. J Infect Dis 1994; 170(5): 1264–7CrossRefPubMedGoogle Scholar
  104. 104.
    Gerna G, Baldanti F, Middeldorp JM, et al. Clinical significance of expression of human cytomegalovirus pp67 late transcript in heart,lung and bone marrow transplant recipients as determined by nucleic acid sequence-based amplification. J Clin Microbiol 1999; 37(4): 902–11PubMedGoogle Scholar
  105. 105.
    Balfour Jr HH. Management of cytomeglovirus disease with antiviral drugs. Rev Infect Dis. 1990; 12Suppl. 7: S849–60CrossRefPubMedGoogle Scholar
  106. 106.
    Chrisp P, Clissold SP. Foscarnet. A review of its antiviral activity, pharmacokinetic properties and therapeutic use in immunocompromised patients with cytomegalovirus retinitis. Drugs 1991; 41(1): 104–29CrossRefPubMedGoogle Scholar
  107. 107.
    Crumpacker CS. Ganciclovir. N Engl J Med 1996; 335(10): 721–9CrossRefPubMedGoogle Scholar
  108. 108.
    Lalezari JP, Stagg RJ, Kuppermann BD, et al. Intravenous cidofovir for peripheral cytomegalovirus retinitis in patients with AIDS. A randomized, controlled trial. Ann Int Med 1997; 126: 257–63PubMedGoogle Scholar
  109. 109.
    Alrabiah FA, Sacks SL. New antiherpesvirus agents, their targets and therapeutic potential. Drugs 1996; 52(1): 17–32CrossRefPubMedGoogle Scholar
  110. 110.
    Tyms AS, Scamans EM, Nairn HM. The in vitro activity of acyclovir and related compounds against cytomegalovirus infections. J Antimicrob Chemother 1981; 8(1): 65–72CrossRefPubMedGoogle Scholar
  111. 111.
    Cole NL, Balfour HH. In vitro susceptibility of cytomegalovirus isolates from immunocompromised patients to acyclovir and ganciclovir. Diag Microbiol Infect Dis 1987; 6: 255–61CrossRefGoogle Scholar
  112. 112.
    Wade JC, Hintz M, McGuffin RW, et al. Treatment of cytomegalovirus pneumonia with high dose acyclovir. Am J Med 1982; 73: 249–56CrossRefPubMedGoogle Scholar
  113. 113.
    Weiler S, Blum MR, Doucette M, et al. Pharmacokinetics of the acyclovir pro-drug valaciclovir after escalating single- and multiple-dose administration to normal volunteers. Clin Pharmacol Ther 1993; 54(6): 595–605CrossRefGoogle Scholar
  114. 114.
    Lowance D, Neumayer HH, Legendre CM, et al. Valacyclovir for the prevention of cytomegalovirus disease after renal transplantation. N Engl J Med 1999; 340: 1462–70CrossRefPubMedGoogle Scholar
  115. 115.
    Faulds D, Heel R. Ganciclovir. A review of its antiviral activity, pharmacokinetic properties and therapeutic efficacy in cytomegalovirus infections. Drugs 1990; 39: 597–638CrossRefPubMedGoogle Scholar
  116. 116.
    Noble S, Faulds D. Ganciclovir: an update of its use in the prevention of cytomegalovirus infection and disease in transplant recipients. Drugs 1998; 56(1): 115–46CrossRefPubMedGoogle Scholar
  117. 117.
    Kanj SS, Sharara AI, Clavien PA, et al. Cytomegalovirus infection following liver transplantation: review of the literature. Clin Infect Dis 1996; 22(3): 537–49CrossRefPubMedGoogle Scholar
  118. 118.
    Trulock EP. Lung transplantation. Am J Respir Crit Care Med 1997; 155: 789–818PubMedGoogle Scholar
  119. 119.
    Foerster M, Kastner U, Neubert R. Effect of six virustatic nucleoside analogues on the development of fetal rat thymus in organ culture. Arch Toxicol 1992; 66(10): 688–99CrossRefPubMedGoogle Scholar
  120. 120.
    Sawyer MD, Mayoral JL, Gillingham KJ, et al. Treatment of recurrent cytomegalovirus disease in patients receiving solid organ transplants. Arch Surg 1993; 128: 165–70CrossRefPubMedGoogle Scholar
  121. 121.
    Harada K, Eizuru Y, Isashiki Y, et al. Genetic analysis of a clinical isolate of human cytomegalovirus exhibiting resistance against both ganciclovir and cidofovir. Arch Virol 1997; 142(2): 215–25CrossRefPubMedGoogle Scholar
  122. 122.
    Lurain NS, Animons HC, Kapell KS, et al. Molecular analysis of human cytomegalovirus strains from two lung transplant recipients with the same donor. Transplantation 1996; 62(4): 497–502CrossRefPubMedGoogle Scholar
  123. 123.
    Rosen HR, Benner KG, Flora KD, et al. Development of ganciclovir resistance during treatment of primary cytomegalovirus infection after liver transplantation. Transplantation 1997; 63(3): 476–8CrossRefPubMedGoogle Scholar
  124. 124.
    Alain S, Honderlick P, Grenet D, et al. Failure of ganciclovir treatment associated with selection of a ganciclovir-resistant cytomegalovirus strain in a lung transplant recipient. Transplantation 1997; 63(10): 1533–6CrossRefPubMedGoogle Scholar
  125. 125.
    Baldanti F, Simoncini L, Sarasini A, et al. Ganciclovir resistance as a result of oral ganciclovir in a heart transplant recipient with multiple human cytomegalovirus strains in the blood. Transplantation 1998; 66(3): 324–9CrossRefPubMedGoogle Scholar
  126. 126.
    Martin M, Snydman DR. How effective is oral ganciclovir? Transplant Proc 1996; 28(6) Suppl 2: 14–5PubMedGoogle Scholar
  127. 127.
    Drew WL, Ive D, Lalezari JP, et al. Oral ganciclovir as maintenance treatment for cytomegalovirus retinitis in patients with AIDS. Syntex Cooperative Oral Ganciclovir Study Group. N Engl J Med 1995; 333(10): 615–20CrossRefPubMedGoogle Scholar
  128. 128.
    Spector SA, Busch DF, Follansbee S, et al. Pharmacokinetic, safety and antiviral profiles of oral ganciclovir in persons infected with human immunodeficiency virus: a phase I/II study. AIDS Clinical Trials Group, and cytomegalovirus Cooperative Study Group. J Infect Dis 1995; 171(6): 1431–7CrossRefPubMedGoogle Scholar
  129. 129.
    Taburet AM, Singlas E. Drug interactions with antiviral drugs. Clin Pharmacokinet 1996; 30(5): 385–401CrossRefPubMedGoogle Scholar
  130. 130.
    Nankivell BJ, Malouf MA, Russ GR, et al. Maintenance therapy with oral ganciclovir after treatment of cytomegalovirus infection. Clin Transplant 1998; 12(3): 270–3PubMedGoogle Scholar
  131. 131.
    Manischewitz JF, Quinnan GJ, Lane H, et al. Synergistic effect of ganciclovir and foscarnet on cytomegalovirus replication in vitro. Antimicrob Agents Chemother 1990; 34(2): 373–5CrossRefPubMedGoogle Scholar
  132. 132.
    Neyts J, Andrei G, De Clercq E. The novel immunosuppressive agent mycophenolate mofetil markedly potentiates the antiherpesvirus activities of acyclovir, ganciclovir, and penciclovir in vitro and in vivo. Antimicrob Agents Chemother 1998; 42(2): 216–22PubMedGoogle Scholar
  133. 133.
    Becker BN, Schulman G. Nephrotoxicity of antiviral therapies. Curr Opin Nephrol Hypertens 1996; 5(4): 375–9CrossRefPubMedGoogle Scholar
  134. 134.
    Ernst ME, Franey RJ. Acyclovir- and ganciclovir-induced neurotoxicity. Ann Pharmacother 1998; 32(1); 111–3CrossRefPubMedGoogle Scholar
  135. 135.
    Buhles W. Clinical safety of IV ganciclovir. In: Spector S, editor. Ganciclovir therapy for cytomegalovirus infection. New York: Marcel Dekker, 1991: 246Google Scholar
  136. 136.
    Enright H, Haake R, Weisdorf D, et al. Cytomegalovirus pneumonia after bone marrow transplantation. Risk factors and response to therapy. Transplantation 1993; 55(6): 1339–46CrossRefPubMedGoogle Scholar
  137. 137.
    George MJ, Snydman DR, Werner BJ, et al. Use of ganciclovir plus cytomegalovirus immune globulin to treat cytomegalovirus pneumonia in orthotopic liver transplant recipients. The Boston Center for Liver Transplantation CMVIG-Study Group. Transplant Proc 1993; 25 (5 Suppl. 4): 22–4PubMedGoogle Scholar
  138. 138.
    Beadle JR, Kini GD, Aidera KA, et al. Alkylthioglycerol pro-drugs of foscarnet: synthesis, oral bioavailability and structure-activity studies in human cytomegalovirus-, herpes simplex virus type 1- and human immunodeficiency virus type 1-infected cells. Antiviral Chem Chemother 1998; 9: 33–40Google Scholar
  139. 139.
    Crumpacker CS. Mechanism of action of foscarnet against viral polymerases. Am J Med 1992; 92(2A): 3S–7SCrossRefPubMedGoogle Scholar
  140. 140.
    Baldanti F, Sarasini A, Silini E, et al. Four dually resistant human cytomegalovirus strains from AIDS patients: single mutations in UL97 and UL54 open reading frames are responsible for ganciclovir- and foscarnet-specific resistance, respectively. Scand J Infect Dis 1995; 99 Suppl.: 103–4Google Scholar
  141. 141.
    Sarasini A, Baldanti F, Furione M, et al. Double resistance to ganciclovir and foscarnet of four human cytomegalovirus strains recovered from AIDS patients. J Med Virol 1995; 47(3): 237–44CrossRefPubMedGoogle Scholar
  142. 142.
    Deray G, Martinez F, Katlama C, et al. Foscarnet nephrotoxicity mechanism, incidence and prevention. Am J Nephrol 1989; 9: 316–21CrossRefPubMedGoogle Scholar
  143. 143.
    Flaherty Jr JF. Current and experimental therapeutic options for cytomegalovirus disease. Am J Health-Syst Pharm 1996; 53Suppl. 2: S4–11PubMedGoogle Scholar
  144. 144.
    Jayaweera DT. Minimising the dosage-limiting toxicities of foscarnet induction therapy. Drug Saf 1997; 16(4): 258–66CrossRefPubMedGoogle Scholar
  145. 145.
    Naesens L, Snoeck R, Andrei G, et al. HPMPC (cidofovir), PMEA (adefovir) and related acyclic nucleoside phosphonate analogues: a review of their pharmacology and clinical potential in the treatment of viral infections. Antiviral Chem Chemother 1997; 8: 1–23Google Scholar
  146. 146.
    Pari GS, Field AK, Smith JA. Potent antiviral activity of an antisense oligonucleotide complementary to the intron-exon boundary of human cytomegalovirus genes UL36 and UL37. Antimicrob Agents Chemother 1995; 39(5): 1157–61CrossRefPubMedGoogle Scholar
  147. 147.
    Anderson KP, Fox MC, Brown-Driver V, et al. Inhibition of human cytomegalovirus immediate-early gene expression by an antisense oligonucleotide complementary to immediateearly RNA. Antimicrob Agents Chemother 1996; 40(9): 2004–11PubMedGoogle Scholar
  148. 148.
    Scholz M, Cinatl Jr J, Doerr HW. Prophylaxis of cytomegalovirus disease in high-risk patients. Infection 1997; 25(5): 269–73CrossRefPubMedGoogle Scholar
  149. 149.
    Sayers MH, Anderson KC, Goodnough LT, et al. Reducing the risk for transfusion-transmitted cytomegalovirus infection. Ann Int Med 1992; 116:55–62PubMedGoogle Scholar
  150. 150.
    Wilhelm JA, Matter L, Schopfer K. The risk of transmitting cytomegalovirus to patients receiving blood transfusions. J Infect Dis 1986; 154(1): 169–71CrossRefPubMedGoogle Scholar
  151. 151.
    Preiksaitis JK, Brown L, McKenzie M. The risk of cytomega-lovirus infection in seronegative transfusion recipients not receiving exogenous immunosuppression. J Infect Dis 1988; 157(3): 523–9CrossRefPubMedGoogle Scholar
  152. 152.
    Plotkin SA. Vaccines for varicella-zoster virus and cytomega-lovirus recent progress. Science 1994; 265(5177): 1383–5CrossRefPubMedGoogle Scholar
  153. 153.
    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: original article series 1984; 20(1): 289–304Google Scholar
  154. 154.
    Plotkin SA, Starr SE, Friedman HM, et al. Effect of Towne live virus vaccine on cytomegalovirus disease after renal transplant. Ann Int Med 1991; 114: 525–31PubMedGoogle Scholar
  155. 155.
    Plotkin SA, Higgins R, Kurtz JB, et al. Multicenter trial of Towne strain attenuated virus vaccine in seronegative renal transplant recipients. Transplantation 1994; 58: 1176–8PubMedGoogle Scholar
  156. 156.
    Wang JB, Adler SP, Hempfling S, et al. Mucosal antibodies to human cytomegalovirus glycoprotein B occur following both natural infection and immunization with human cytomegalovirus vaccines. J Infect Dis 1996; 174: 387–92CrossRefPubMedGoogle Scholar
  157. 157.
    Britt WJ. Vaccines against human cytomegalovirus: time to test. Trends Microbiol 1996; 4(1): 34–8CrossRefPubMedGoogle Scholar
  158. 158.
    Marshall GS, Ricciardi RP, Rando RF, et al. An adenovirus recombinant that expresses the human cytomegalovirus major envelope glycoprotein and induces neutralizing antibodies. J Infect Dis 1990; 162(5): 1177–81CrossRefPubMedGoogle Scholar
  159. 159.
    Jassal SV, Roscoe JM, Zaltzman JS, et al. Clinical practice guidelines: prevention of cytomegalovirus disease after renal transplantation. J Am Soc Nephrol 1998; 9: 1697–708PubMedGoogle Scholar
  160. 160.
    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: 1049–54CrossRefPubMedGoogle Scholar
  161. 161.
    Snydman DR. Review of the efficacy of cytomegalovirus immune globulin in the prophylaxis of CMV disease in renal transplantrecipients. Transplant Proc 1993; 25 (5 Suppl. 4): 25–6PubMedGoogle Scholar
  162. 162.
    Werner BG, Snydman DR, Freeman R, et al. Cytomegalovirus immune globulin for the prevention of primary cytomegalovirus disease in renal transplant patients: analysis of usage under treatment IND status. The Treatment IND Study Group. Transplant Proc 1993; 25 (1 Pt 2): 1441–3PubMedGoogle Scholar
  163. 163.
    Tsevdt J, Snydman DR, Pauker SG, et al. Which renal transplant patients should receive cytomegalovirus immune globulin? Transplantation 1991; 52: 259–65CrossRefGoogle Scholar
  164. 164.
    King SM, Superina R, Andrews W, et al. Randomized comparison of ganciclovir plus intravenous immune globulin (IVIG) with intravenous immune globulin alone for prevention of primary cytomegalovirus disease in children receiving liver transplants. Clin Infect Dis 1997; 25(5): 1173–9CrossRefPubMedGoogle Scholar
  165. 165.
    Wittes JT, Kelly A, Plante KM. Meta-analysis of CMVIG studies for the prevention and treatment of CMV infection in transplant patients. Transplant Proc 1996; 28Suppl. 2: 17–24PubMedGoogle Scholar
  166. 166.
    Boland GJ, Ververs C, Hene RJ, et al. Early detection of primary cytomegalovirus infection after heart and kidney transplantation and the influence of hyperimmune globulin prophylaxis. Transplant Int 1993; 6(1): 34–8CrossRefGoogle Scholar
  167. 167.
    Fassbinder W, Ernst W, Hanke P, et al. Cytomegalovirus infections after renal transplantation: effect of prophylactic hyperimmunoglobulin. Transplant Proc 1986; 18: 1393–6Google Scholar
  168. 168.
    Snydman DR, Werner BG, Dougherty NN, et al. Cytomegalovirus immune globulin prophylaxis in liver transplantation: a randomized, double blind, placebo controlled trial. Ann Intern Med 1993; 119: 984–91PubMedGoogle Scholar
  169. 169.
    Valenza M, Czer LS, Pan SH, et al. Combined antiviral and immunoglobulin therapy as prophylaxis against cytomegalovirus infection after heart transplantation. J Heart Lung Transplant 1995; 14(4): 659–65PubMedGoogle Scholar
  170. 170.
    Gutierrez CA, Chaparro C, Krajden M, et al. Cytomegalovirus viremia in lung transplant recipients receiving ganciclovir and immune globulin. Chest 1998; 113(4): 924–32CrossRefPubMedGoogle Scholar
  171. 171.
    Rostaing L, Martinet O, Cisterne JM, et al. CMV prophylaxis in high-risk renal transplant patients (D+/R-) by acyclovir with or without hyperimmune (CMV) immunoglobulins: a prospective study. Am J Nephrol 1997; 17: 489–94CrossRefPubMedGoogle Scholar
  172. 172.
    Balfour Jr HH, Chace BA, Stapelton 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: 1381–7CrossRefPubMedGoogle Scholar
  173. 173.
    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: 876–84CrossRefPubMedGoogle Scholar
  174. 174.
    Gavalda J, de Otero J, Murio E, et al. Two grams daily of oral acyclovir reduces the incidence of cytomegalovirus disease in cytomegalovirus-seropositive liver transplant recipients. Transplant Int 1997; 10:462–5CrossRefGoogle Scholar
  175. 175.
    Barkholt L, Lewensohn-Fuchs I, Ericzon BG, et al. High-dose acyclovir prophylaxis reduces cyomegalovirus disease in liver transplant patients. Transplant Infect Dis 1999; 1: 89–97CrossRefGoogle Scholar
  176. 176.
    Kletzmayr J, Kotzmann H, Popow-Kraupp T, et al. Impact of high-dose oral acyclovir prophylaxis on cytomegalovirus (CMV) disease in CMV high-risk renal transplant recipients. J Am Soc Nephrol 1996; 7(2): 325–30PubMedGoogle Scholar
  177. 177.
    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: 69–74CrossRefPubMedGoogle Scholar
  178. 178.
    Martin M, 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
  179. 179.
    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
  180. 180.
    Mullen GM, Silver MA, Malinowska K, et al. Effective oral ganciclovir prophylaxis against cytomegalovirus disease in heart transplant recipients. TransplantProc 1998; 30(8): 4110–2CrossRefGoogle Scholar
  181. 181.
    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: 1182–6CrossRefPubMedGoogle Scholar
  182. 182.
    Somerville T, Hurst G, Alloway R, et al. Superior efficacy of oral ganciclovir over oral acyclovir for cytomegalovirus prophylaxis in kidney-pancreas and pancreas alone recipients. Transplant Proc 1998; 30: 1546–8CrossRefPubMedGoogle Scholar
  183. 183.
    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(3): 548–52CrossRefPubMedGoogle Scholar
  184. 184.
    Paradis IL, Williams P. Infection after lung transplantation. Semin Respir Infect 1993; 8(3): 207–15PubMedGoogle Scholar
  185. 185.
    Duncan SR, Grgurich WF, Iacono 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
  186. 186.
    Gane E, Saliba F, Valdecasas Garcia JC, et al. Randomised trial of efficacy and safety of oral ganciclovir in the prevention of cytomegalovirus disease in liver-transplant recipients. Lancet 1997; 350(9093): 1729–33CrossRefPubMedGoogle Scholar
  187. 187.
    Flechner SM, Avery RK, Fisher R, et al. A randomized prospective controlled trial of oral acyclovir versus oral ganciclovir for cytomgalovirus prophylaxis in high-risk kidney transplant recipients. Transplantation 1998; 66(12): 1682–8CrossRefPubMedGoogle Scholar
  188. 188.
    Brennan DC, Garlock KA, Singer GG, et al. Prophylactic oral ganciclovir compared with deferred therapy for control of cytomegalovirus in renal transplant recipients. Transplantation 1997; 64(12): 1843–6CrossRefPubMedGoogle Scholar
  189. 189.
    Yang HC, Holman MJ, Langhoff E, et al. A comparative study of 500mg bid and 250 mg bid of prophylactic oral ganciclovir in post-kidney transplant ‘CMV at risk’ recipients. Transplant Proc 1999; 31: 1125–6CrossRefPubMedGoogle Scholar
  190. 190.
    Ahsan N, Holman MJ, Sonderbye L, et al. Oral ganciclovir in the prevention of cytomegalovirus infection in postkidney transplant ‘CMVat risk’ recipients: a controlled, comparative study of two regimens (750 m bid and 500 mg bid). Transplant Proc 1998; 30: 1383–5CrossRefPubMedGoogle Scholar
  191. 191.
    Riddell SR, Watanabe KS, Goodrich JM, et al. Restoration of viral immunity in immunodeficient humans by the adoptive transfer of T cell clones. Science 1992; 257(5067): 238–41CrossRefPubMedGoogle Scholar
  192. 192.
    Walter EA, Greenberg PD, Gilbert MJ, et al. Reconstitution o cellular immunity against cytomegalovirus in recipients of allogeneic bone marrow by transfer of T-cell clones from the donor. N Engl J Med 1995; 333(16): 1038–44CrossRefPubMedGoogle Scholar
  193. 193.
    Rubin RH. Preemptive therapy in immunocompromised hosts. N Engl J Med 1991; 324: 1057–9CrossRefPubMedGoogle Scholar
  194. 194.
    Iberer F, Tscheliessnigg K, Halwachs G, et al. Definitions of cytomegalovirus disease after heart transplantation: antigenemia as a marker for antiviral therapy. Transplant Int 1996; 9(3): 236–42CrossRefGoogle Scholar
  195. 195.
    Egan JJ, Lomax J, Barber L, et al. Preemptive treatment for the prevention of cytomegalovirus disease: in lung and heart transplant recipients. Transplantation 1998; 65(5): 747–52CrossRefPubMedGoogle Scholar
  196. 196.
    Gotti E, Suter F, Baruzzo S, et al. Early ganciclovir therapy effectively controls viremia and avoids the need for cytomegalovirus (CMV) prophylaxis in renal transplant patients with cytomegalovirus antigenemia. Clin Transplant 1996; 10 (6 Pt 1): 550–5PubMedGoogle Scholar
  197. 197.
    Himmelmann-Jud, B, Wuthrich RP, Weinreich T, et al. Successful use of oral valacyclovir in post-transplant cytomegalovirus infection in renal allograft recipients. Nephrol Dial Transplant 1998; 13(5): 1326–7CrossRefPubMedGoogle Scholar
  198. 198.
    Winston DJ. Prevention of cytomegalovirus disease in transplant recipients. Lancet 1995; 346(8987): 1380–1CrossRefPubMedGoogle Scholar

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© Adis International Limited 2000

Authors and Affiliations

  1. 1.Division of Infectious Diseases and Internal MedicineMayo Clinic and FoundationRochesterUSA

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