Evaluation of low dose famciclovir as herpes simplex virus and varicella zoster virus prophylaxis in cytomegalovirus low-risk solid organ transplant recipients.

OBJECTIVE

Famciclovir is a recommended option for herpes simplex virus (HSV) and varicella-zoster virus (VZV) prophylaxis in cytomegalovirus (CMV) low-risk solid organ transplant (SOT) recipients in current guidelines; however there is currently no data evaluating its use in SOT recipients. We conducted a multicenter provider survey on antiviral prophylaxis in CMV low-risk SOT recipients and evaluated the efficacy and safety of once daily famciclovir antiviral prophylaxis.

METHODS

Two-part analysis consisting of a national provider survey and a retrospective chart review of 78 kidney transplant recipients at a single institution.

RESULTS

Providers from 45 transplant centers within the United States responded to the survey. Across all organs, acyclovir 400 mg twice daily was utilized by the majority of respondents (70.4%), with most using prophylaxis for a duration of 3 months (68.8%). No respondents reported use of famciclovir at their institution. In the retrospective review there were no documented cases of HSV/VZV/CMV infection during the 3 months of famciclovir prophylaxis, and only one patient (1.3%) later developed VZV infection at 12 months post-transplant. One patient (1.3%) required premature discontinuation of famciclovir due to concern for acute interstitial nephritis.

CONCLUSION

Nationwide, the most common antiviral prophylaxis used in CMV low-risk SOT recipients is acyclovir 400 mg twice daily. Among patients receiving once daily famciclovir for CMV low-risk antiviral prophylaxis, there was no HSV/VZV/CMV infection while on prophylaxis. Once daily famciclovir may provide an effective and convenient once daily dosing regimen for antiviral prophylaxis in CMV low-risk SOT recipients.