The Role of Ganciclovir in Transplantation

Virologic infections are common post-transplantation and negatively impact graft survival. Cytomegalovirus (CMV) is the most prominent of these viral infections. With the introduction of more potent immunosuppression and increased transplant allograft longevity, CMV continues to be a major cause of morbidity and mortality in transplant recipients. The utilization of preventative strategies against CMV with potent antivirals has led to successful minimization of CMV infection and disease. Numerous clinical trials have demonstrated the efficacy of both ganciclovir and valganciclovir for the treatment and prevention of CMV post-transplantation. Ganciclovir exhibits a minimal drug interaction profile and its reported adverse effects are predominantly hematologic in nature. Given its improved oral bioavailability, and a presumed lower risk of ganciclovir resistance, and equal efficacy, valganciclovir appears to be a superior alternative to ganciclovir for the prevention of CMV in transplant recipients.