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NDT Advance Access originally published online on April 20, 2006
Nephrology Dialysis Transplantation 2006 21(7):1757-1761; doi:10.1093/ndt/gfl151
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Editorial Comment

CMV prophylaxis—to do or not to do, that is the question

Ban Hock Tan

Department of Internal Medicine and Infectious Disease Unit, Singapore General Hospital, Singapore

Correspondence and offprint requests to: B. H. Tan. Email: tan.ban.hock@sgh.com.sg

Keywords: cytomegalovirus; ganciclovir prophylaxis; kidney transplantation; pre-emptive therapy

The first 150 words of the full text of this article appear below.



   Introduction
 
Cytomegalovirus (CMV) is the major microbe adversely affecting transplantation [1]. The CMV syndrome has been recognized from the early days of renal transplantation. In the pre-ganciclovir (GCV) era, the only treatment was reduction of immunosuppression [2].

In transplantation, preventing an infection is as important as, if not more important than, treating one; hence prophylaxis. Trimethorprim-sulfamethoxazole (TMP-SMX) prophylaxis has reduced the frequency of Pneumocystis pneumonia (PCP). In transplant recipients, CMV has both direct effects (e.g. colitis) and indirect ones. The latter include graft rejection and susceptibility to bacterial or fungal infection, among others [3].

There should, therefore, be no question regarding the importance of CMV prophylaxis in transplantation. If an agent is available that is effective, safe, easy to administer and not too expensive, then it should be given to every transplant recipient.

The role of prophylaxis is being questioned because of an attractive alternative: . . . [Full Text of this Article]

Prophylaxis
Pre-emptive therapy
Problems with prophylaxis
Problems with PRE
Prophylaxis vs PRE
PRE—biologically superior?
Cost


   Conclusion
 

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