4. Clinical Guidelines for Liver Transplantation (PDF) - British ...

Guidebook for the Solid Organ Transplant Programme Chapter 4
CMV PROPHYLAXIS AND TREATMENT REGIMENS FOR LIVER TRANSPLANT RECIPIENTS Appendix I
CMV STATUS
THERAPY
DONOR RECIPIENT PROPHYLAXIS PRE-EMPTIVE TREATMENT DISEASE TREATMENT
Negative Negative No prophylactic Valganciclovir
If CMV PCR > 1000 cp/mL follow treatment protocol
CMV PCR testing with bloodwork (maximum q weekly) for
4 months post-transplant and for 2 months following any
antiviral treatment.
Asymptomatic:
Valganciclovir 900 mg PO bid adjusted for renal function
for 2 weeks followed by 900 mg PO daily for 4 months.
Symptomatic:
Ganciclovir 5 mg/kg/dose q 12h IV adjusted for renal
function x 2 weeks followed by Valganciclovir 900 mg PO
daily adjusted for renal function for 4 months.
Positive
(Mismatch)
Negative
Ganciclovir 5mg/kg/dose q 12h IV adjusted for renal
function x 14 days or until hospital discharge, then
Valganciclovir 900 mg PO daily adjusted for renal
function until 4 months post transplant.
During Lymphocyte Depleting Therapies:
Ganciclovir 5 mg/kg/dose q 12h IV adjusted for renal
function or Valganciclovir 900mg PO daily adjusted for
renal function for 2 months.
If CMV PCR > 1000 cp/mL and patient is asymptomatic
then:
Valganciclovir 900 mg PO daily adjusted for renal
function until CMV PCR test is < 1000 cp/mL for 2
consecutive weeks and patient is clinically stable
(minimum 1 month therapy)
Increase Valganciclovir dose to 900 mg PO bid
adjusted for renal function if CMV PCR is rising
Ganciclovir 5 mg/kg/dose q 12h IV adjusted for renal
function x 2 weeks followed by Valganciclovir 900 mg
PO daily adjusted for renal function for 4 months.
If no diarrhea, consider:
Valganciclovir 900 mg PO bid adjusted for renal function
x 2 weeks followed by Valganciclovir 900 mg PO daily
adjusted for renal function for 4 months.
Positive OR
Negative
Positive
CMV PCR testing with bloodwork (maximum q weekly) for
6 months post-transplant and for 2 months following any
antiviral treatment.
No prophylactic Valganciclovir
During Lymphocyte Depleting Therapies
Ganciclovir 5 mg/kg/dose q 12h IV adjusted for renal
function or Valganciclovir 900 mg PO daily adjusted for
renal function for 2 months.
CMV PCR testing with bloodwork (maximum q weekly) for
4 months post-transplant and for 2 months following any
antiviral treatment.
If CMV PCR > 5000 cp/mL and patient is asymptomatic
then:
Valganciclovir 900 mg PO daily adjusted for renal
function until CMV PCR test is < 2000 cp/mL and
decreasing for 2 consecutive weeks and patient is
clinically stable (minimum 1 month therapy).
Increase Valganciclovir dose to 900 mg PO bid
adjusted for renal function if CMV PCR is rising.
Ganciclovir 5 mg/kg/dose q 12h IV adjusted for renal
function x 2 weeks followed by Valganciclovir 900 mg
PO daily adjusted for renal function for at least 2 weeks
(CMV PCR test should be < 2000 cp/mL and decreasing
for 2 consecutive weeks and patient clinically stable prior
to discontinuation of Valganciclovir).
If no diarrhea, consider:
Valganciclovir 900 mg PO bid adjusted for renal function
x 2 weeks followed by Valganciclovir 900 mg PO daily
adjusted for renal function for at least 2 weeks (CMV PCR
test should be < 2000 cp/mL and decreasing for 2
consecutive weeks and patient clinically stable prior to
discontinuation of Valganciclovir).
Hepatitis C positive recipient (donor or recipient CMV +) Follow mismatch protocol
Oral Valganciclovir tablets are supplied free of charge through the BCT Pharmacy Program for outpatients on the above protocol.
If total WBC is less than 2.5 x 10 9 /L decrease Valganciclovir dose to 450 mg PO daily.
If total WBC is less than 1.5 x 10 9 /L hold Valganciclovir until WBC is greater than 3.5 x 10 9 /L, then restart Valganciclovir at 450 mg PO daily. December 11, 2008
Chapter 4 – Clinical Guidelines for Liver Transplantation – July, 2010 Page 50
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