The CARI guidelines. CMV disease and kidney transplant: prophylaxis for cytomegalovirus infection in patients following renal transplantation.

a. Prophylactic treatment for Cytomegalovirus (CMV) is recommended in solid organ transplantation as it is associated with a significant decrease in CMV disease and infection compared with placebo or no treatment (approximately a 50% and 40% decrease in relative risk, respectively) (Level I evidence). b. The use of the antiviral agents oral valganciclovir, oral valaciclovir, and intravenous ganciclovir, is recommended (Level II evidence). The addition of anti-CMV immunoglobulin to these agents is not recommended as there is no additional benefit (Level I evidence). c. On the pre-transplant CMV antibody assay, prophylaxis for CMV disease is indicated for the following donor/recipient subgroups: D+ and R+ D+ and RD-/R+ but not when Donor and Recipient are both negative. d. In high risk, D+/Rrecipients, it is recommended that the duration of prophylaxis be extended from 3 to 6 months as it significantly reduces CMV disease and viraemia.