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Important: Protocol superseded July 2009 - see new version here at www.edren.co.uk.
That website is in development - you can ignore the 'This website is not ready' signs ONLY for the Transplant protocols. Others are not updated or fully transferred. |
Valganciclovir is prescribed for prevention of CMV disease in high risk transplant patients identified as follows:
Prescription is initiated in hospital within 10 days of transplantation. Therapy will be continued in primary care for up to a total of 90 days treatment for which a shared-care protocol will be provided.
Valganciclovir is available as 450mg tablets (pink) and the brand name is Valcyte®. The tablets should be taken with food and not broken or crushed.
The initial valganciclovir dose is dependent on renal function as shown in the table below:
|
Creatinine clearance (ml/min) |
Prophylactic dose |
|
>60 |
900mg od |
|
40 to 59 |
450mg od |
|
25 to 39 |
450mg every 2 days |
|
10 to 24 |
450mg twice weekly |
FBC and LFTs must be monitored daily during therapy.
Surveillance is not routine since introduction of valganciclovir. Investigate any episode of illness which might be CMV related, at any stage following a transplant operation.
Check CMV serology together with samples of EDTA bloodfor buffy coat culture and serum sample for PCR. These should be requested following discussion with the Virologist.
An EDTA (9 ml or 3 x 2.5 mls sample for CMV should be sent to Virology whenever is clinically relevant. ON request form include details of illness (e.g. pyrexia or hepatitis etc.) Request CMV PCR and CMV culture. Please try to ensure samples reach Virus Lab by midday, and within 2h. The rapid culture may provide an answer sooner than PCR in some cases.
It will often be appropriate to send respiratory or other samples to virology - bronchoalveolar lavage or induced sputum for investigation as usual or colon biopsies.
Transplant protocols developed on the Edinburgh Transplant Unit. This page first published March 2002 by Amit Adlakha, updated December 2006 and last modified
NOTE that the accuracy of any statements in this information CANNOT be guaranteed. It is published in the belief that it is correct, and we endeavour to keep it so - but we do make mistakes. Furthermore, over some subjects there are differing opinions, or differing degrees of certainty. We have usually not attempted to discuss these here because the aim has been to provide an immediate and brief guide. In all areas, prior medical knowledge is assumed. The EdRenHANDBOOK is not suitable for use by those without such a background. Contact us by email or at the address given at the foot of the contents page with any comments or corrections.