CMV Prophylaxis in Heart Transplant Recipients
Donor CMV
status
Recipient
CMV
Status
Risk
Monitoring
Therapy

Positive
Positive
Negative
HIGH
Negative
Acyclovir 400mg twice daily (PO
or PT) until POD 7-10

Valcyte 900mg** daily upon
discharge or at POD#14 (see note)–
continue for 3-6 months

Resume acyclovir 400mg BID and
adjust for renal function

Stop therapy at 1 yr post-tx

Acyclovir 400mg twice daily PO or
PT) until POD 7-10

Valcyte 900mg** daily upon
discharge or at POD#14 for 3
months

Consider resuming acyclovir 400
mg twice daily and adjust for renal
function

Stop therapy at 6 months post-tx
If pt in HIGH risk
category with a
significant rejection and
high dose steroid or
antibody therapy --continue Valcyte for 6
months post tx and
resume acyclovir 800mg
TID thereafter
Positive
Moderate
Negative
CMV antigenemia
every month after
stopping Valcyte
therapy
Notes
Positive
Negative
Low
CMV antigenemia
every month after
stopping Valcyte
therapy
CMV antigenemia
q 2 weeks x 3
months, then
check IgG &IgM
for seroconversion

If the patient stays in the
hospital longer than 14
days post operatively,
start Valcyte at
POD#14
Acyclovir 400 twice daily for 6
months post-tx
**Decrease VALCYTE dose based on renal function (see chart)
Renal Dosing of Valcyte
(Valganciclovir)
Induction/ Treatment dose
Prophylaxis/ Maintenance Dose
CrCl ≥ 60ml/min
900 mg twice daily
900 mg daily (or 450 twice daily)
900 mg once daily (or 450 twice daily)
450 mg daily
450 mg daily
450 mg every other day
450 mg every other day
450 mg twice weekly
CrCl 69-40 ml/min
CrCl 39-25 ml/min
CrCl 25-10 ml/min
References:
Akalin JS, Bronberg V, Shegal S, et al. Six months valganciclovir prophylaxis significantly decreased cytomegalovirus infection incidence in thymoglobulin treated patients. Am
J Transplant 2004(4):495.
Valcyte [package insert]. Philadelphia, PA: Wyeth; September 2007.
Kalil AC, Levitsky J, Lyden E, et al. Meta Analysis: the efficacy of strategies to prevent organ disease by cytomegalovirus in solid organ transplant recipients. Ann Intern Med
2005; 143: 870-80.
Cvetkovic RS, Wellington K. Valganciclovir: A review of its use in the management of CMV infection and disease in immunocompromised patients. Drugs 2005; 65(6):859-78.
Kusne S, Shapiro R, Fung J, et al. Prevention and treatment of cytomegalovirus infection in organ transplant recipients. Transpl Infect Dis. 1999;1:187-203.
Singh N. Preemptive therapy versus universal prophylaxis with Ganciclovir for CMV in solid organ transplant recipients. Clin Infect Dis. 2001; 32: 742-51.
Khoury JA, Storch GA, Bohl DL, et al. Prophylactic versus preemptive oral valganciclovir for the management of CMV infection in adult renal transplant recipients. Am J
Transplantation. 2006; 6:2134-2143.
Singh N. Cytomegalovirus infection in solid organ transplant recipients: new challenges and their implications for preventive strategies. J Clin Virol. 2006; 35 (4):474-44.
Revised 9/2007