Oral valganciclovir versus intravenous ganciclovir as preemptive treatment for cytomegalovirus infection after living donor liver transplantation: A randomized trial

Cytomegalovirus (CMV) is one of the most common infectious complications after living donor liver transplantation (LDLT). Three etiologies of CMV infection in LDLT recipients are proposed; viral transmission via the donor graft, viral transmission via transfusion from a sero-positive donor, and reactivation of dormant CMV in the recipients (1). Approximately 23% to 85% recipients after liver transplantation develop CMV infection, and 15% to 40% (1-3) of them develop CMV-related disease, such as interstitial pneumonia, hepatitis, and enteritis. CMV infection is also reported to be the cause of other infectious complications, such as acute rejection, poor survival rate, increased graft loss, increased length of hospital stay, and high cost. Therefore, the establishment of optimal strategies, including the most effective antiviral agents and the most effective administration route for preventing CMV infection or disease after LDLT is in high demand. Two strategies are currently acceptable for the prevention of CMV-related morbidity or mortality after liver transplantation; universal prophylaxis (4-6) and preemptive treatment (7-9). It is controversial whether either strategy is superior to the other, because both strategies have limitations: universal prophylaxis is Original Article