Figure 1025

Randomized trials evaluating cytomegalovirus (CMV) prophylactic strategies administered during the time of greatest risk for CMV disease.

The "prevention" of CMV disease

Preemptive treatment CMV antigenemia testing or PCR testing weekly starting the third or fourth postoperative week or low titer positive-depending on the laboratory th reshold

Treat with IV ganciclovir

5 mg/kg bid adjusted for renal function x10-14d

Antiviral prophylaxis For all CMV D+ R D+ R+, D- R+ the following have been employed *a. po ganciclovir 1 g tid x 3 months b. IV ganciclovir post transplant only or followed by oral acyclovir for 3 months c. Oral high dose acyclovir 800 mg po qid x 3 months d. Pooled IV IgG or CMV hyperimmune globulin iz.

Continue surveillance

Different laboratories have different thresholds for clinically significant positive tests. t The most costly approach.

t The most convenient and effective. Both ganciclovir and acyclovir are adjusted for renal function.

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