Ganciclovir therapy for cytomegalovirus disease associated with renal transplants

Seventeen recipients of renal transplants were treated with ganciclovir for life- or sight-threatening cytomegalovirus (CMV) infection. Twelve patients had pneumonia (one with concomitant retinitis), three patients had retinitis, and two patients had generalized disease. Four (36%) of 11 patients with pneumonia due to CMV were cured, including three (30%) of 10 ventilator-dependent patients. The clinical condition of all four patients with retinitis improved when ganciclovir was administered, although three patients relapsed after discontinuation of therapy. Two of these three responded to a repeat course of therapy. Two patients with generalized disease died. A virologic response, with clearing of CMV, was noted in eight of the 17 patients (including seven of 10 patients with a favorable clinical response). Adverse effects of therapy were common and included leukopenia (six patients), thrombocytopenia (four patients), and CNS disturbances (four patients). Ganciclovir holds promise as therapy for life-threatening CMV infection in patients with renal transplants, including those patients with CMV pneumonia who are ventilator-dependent.