Considering Prophylaxis for Cytomegalovirus Disease in Cytomegalovirus Positive Renal Transplant Recipients from Positive Donors in a Resource Limited South African Public Hospital

Giving cytomegalovirus (CMV) prophylaxis to CMV positive recipients is expensive in a resource-limited setting like South Africa. We report a retrospective analysis of CMV disease in 47 CMV donor/recipient positive (D+/R+) adult renal transplant patients (> 80% African Blacks) from February 2000 to November 2004 who had received four drug induction immune suppression. We commenced routine valganciclovir prophylaxis for 3 months post renal transplant in January 2007 and reviewed incidence of CMV disease from January 2007, in similar patients, until October 2009. Before prophylaxis, incidence of CMV disease was 32% in D+/R+ and was similar to recipient negative/donor positive (D-/R+) patients, however graft survival analysis adjusted for CMV disease showed that D+/R+ recipients had a hazard ratio of 2.8 (p=0.03) for poor graft outcome. After prophylaxis, among deceased donor recipients the incidence of CMV disease over a mean follow up of 17.3 months was 6% (n=2), and nil in live donor recipients. Our immunosuppressive therapy carries a risk of CMV disease in approximately a third of patients and is associated with poorer graft outcomes. CMV prophylaxis has been highly effective at reducing the incidence of CMV disease, and is important in a setting with ever decreasing availability of organs for transplantation. *Corresponding author: G Paget, Division of Nephrology, Faculty of Health Sciences, University of the Witwatersrand and The Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, PO Box 787392, Sandton, 2146, Gauteng, South Africa, Fax: +27866055757; E-mail: [email protected] Received August 25, 2011; Accepted November 10, 2011; Published November 13, 2011 Citation: Paget G, Naicker S (2011) Considering Prophylaxis for Cytomegalovirus Disease in Cytomegalovirus Positive Renal Transplant Recipients from Positive Donors in a Resource Limited South African Public Hospital. J Nephrol Therapeutic 1:104. doi:10.4172/2161-0959.1000104 Copyright: © Paget G, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.