Use of intravenous acyclovir for prophylaxis of cytomegalovirus infection in renal transplant recipients

Objective: To review the incidence and risk factors for cytomegalovirus (CMV) infection and disease following renal transplantation, and the use of intravenous acyclovir for infection prophylaxis. Data Sources: An English- language literature search using MEDLINE (1982-93), Index Medicus (1982-93), and bibliographic reviews of related textbooks and review articles. Study Selection: One hundred forty-five articles were selected. Articles were assessed for study quality and specific information addressing the stated purpose. In articles reporting the results of clinical trials, emphasis was placed on comparative pharmacokinetic parameters, efficacy, and toxicity. Synthesis: A review of human trials suggests that acyclovir is effective for prevention of CMV infection and disease following renal transplantation. When compared with active or passive CMV immunization, ganciclovir, and foscarnet sodium, acyclovir appears to exhibit the most favorable combination of safety and efficacy in the renal transplant population. However, the optimal dose of intravenous acyclovir when compared with oral administration is not clearly established. Conclusions: Acyclovir will continue to be widely used for CMV prophylaxis following renal transplantation. Postoperative complications often require the use of intravenous medications, and the optimal dosing schedule for intravenous acyclovir in this population is an issue that needs to be addressed. A randomized, concentration-controlled clinical trial may be the best approach to establish a safe and effective dosing schedule for intravenous acyclovir administration in the renal transplant population.