Treatment of recurrent cytomegalovirus disease in patients receiving solid organ transplants

Tissue-invasive cytomegalovirus (TI-CMV) disease occurs commonly after solid organ transplantation and has been associated with increased allograft loss and patient mortality. Although ganciclovir has been demonstrated to be an effective form of treatment for TI-CMV disease, therapy may be followed by recurrence. The purpose of this study was to determine the impact of recurrent TI-CMV disease on patient and allograft survival. We studied 619 patients who underwent solid organ transplantation (535 kidney transplants [253 from living related donors and 282 from cadavers] and 84 combined cadaveric kidney-pancreas transplants) during a 3 1/2-year period. One hundred fourteen patients (18.4%) developed TI-CMV disease and were treated with a standardized regimen of intravenous ganciclovir for 14 to 21 days. Of the 114 patients in whom primary TI-CMV disease developed, 28 (24.6%) developed recurrent TI-CMV disease more than 30 days after the initial episode, and these patients were retreated with ganciclovir. Cure rates at 30 days were 98.9% in patients with primary TI-CMV disease and 100% in patients with recurrent TI-CMV disease. Patients who underwent cadaveric kidney or kidney-pancreas transplantation were more likely to develop recurrent TI-CMV disease than were recipients of kidney transplants from living related donors; antirejection therapy also was associated with a higher incidence of recurrent TI-CMV disease. Patients who developed TI-CMV disease exhibited lower rates of graft and patient survival at 3 years than patients without TI-CMV disease or with solely asymptomatic CMV infection, although recurrent TI-CMV disease did not appear to exacerbate morbidity or mortality. We conclude that recurrent episodes of TI-CMV disease do not appear to further adversely affect patient or graft survival in comparison with primary TI-CMV disease in ganciclovir-treated patients.