Increased incidence of cytomegalovirus infection in high‐risk liver transplant recipients receiving valganciclovir prophylaxis versus ganciclovir prophylaxis

Optimal measures for the prevention of cytomegalovirus (CMV) in high‐risk orthotopic liver transplant (OLT) patients are unknown. The charts of high‐risk OLT recipients with 12 months of follow‐up who were transplanted over a 44‐month period were reviewed. The incidence of CMV disease in CMV‐seropositive donor/CMV‐seronegative recipient patients receiving valganciclovir or ganciclovir prophylaxis was compared. Sixty‐six patients met the inclusion criteria and were treated with 1 of 3 prophylactic regimens: valganciclovir (900 mg daily; 27 patients), oral ganciclovir (1000 mg every 8 hours; 17 patients), or intravenous ganciclovir (6 mg/kg daily; 22 patients). Eight CMV cases occurred, all after completion of the prophylaxis. The combined incidence of CMV disease with intravenous and oral ganciclovir was lower than the incidence in valganciclovir recipients (P = 0.056; relative risk, 4.33; 95% confidence interval, 0.94–19.87). CMV disease occurred in 22.2% of valganciclovir recipients, 4.5% of intravenous ganciclovir recipients, and 5.9% of oral ganciclovir recipients. In conclusion, late‐onset CMV disease occurred more frequently among high‐risk liver transplant recipients treated with valganciclovir prophylaxis. The 4‐fold higher incidence of CMV disease in our study supports the avoidance of valganciclovir for prophylaxis in high‐risk OLT patients. Liver Transpl 15:963–967, 2009. © 2009 AASLD.