الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 139 |  |  |
| | | from | 139 | | |
Abstract
CMV infection is one of the common complications after renal transplantation. There is increasing evidence suggesting that CMV infection exerts an adverse impact on patient and graft outcome. CMV-serpositive recipients, who constitute by far the most common risk group among the kidney transplant population, face the risk of either viral reactivation or superinfection. International consensus guidelines recommend antiviral prophylaxis with valganciclovir as the primary method of prevention in CMV-seropositive renal transplant recipients.
There is emerging data in literature concerning alternative measures as low-dose valganciclovir, high-dose valacyclovir and low-dose valacyclovir.
Our study was the first randomized head-to-head trial designed to show the differences in efficacy and safety between low-dose valganciclovir versus low-dose valacyclovir for CMV prophylaxis in an intermediate-risk group of renal transplant recipients and the impact on graft survival.
Sixty live donor kidney transplant CMV-seropositive recipients who were transplanted at Mansoura Urology and Nephrology Center from July 2015 till June 2016. Patients were randomized into two groups. The first group received low-dose valganciclovir (450 mg qd) while the second group received low-dose valacyclovir (2gm bid). Both medications were started within five days from the transplantation for three months. All patients in the two groups were subjected to thorough evaluation including 12 months follow up during which full clinical assessment, chemistry profile, blood picture, quantitative CMV DNA testing using PCR test routinely after 1 month, 3 months, 6 months and 12 months for CMV infection, checking CMV PCR if any suggesting clinical manifestations. Biopsy-proven acute rejections, posttransplant complications and economic costs of the study medications were also studied. Leukopenia was noticed more in valganciclovir group, but with no significant difference. There was no significant difference regarding rejection between the two groups. Regarding posttransplant hypertension and diabetes, the incidence was comparable to other related studies and there was no statistical difference in the two groups.
Concerning CMV infection and disease, there was insignificant statistical difference between the two groups and the incidence was matched with other previous reports. BK nephropathy, herpes zoster and malignancy were not encountered in this study.
Regarding drug study costs, there was a huge statistical significant difference in cost in favor of valacyclovir group. The cost in valganciclovir was more than that in valacyclovir arm by more than 6-folds.
One-year patient survival was 93.3% in valganciclovir arm versus 100% in valacyclovir arm.