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Comment & Response
September 15, 2020

Preemptive Therapy vs Antiviral Prophylaxis in Cytomegalovirus-Seronegative Liver Transplant Recipients With Seropositive Donors—Reply

Author Affiliations
  • 1University of Pittsburgh, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
  • 2University of Washington, Seattle
JAMA. 2020;324(11):1108-1109. doi:10.1001/jama.2020.11865

In Reply The observed rate of breakthrough disease (2%) during prophylaxis in our study1 is consistent with the rate in other clinical studies (1%-4%).2,3 Both CMV disease cases in the prophylaxis group were receiving intermittent hemodialysis and kidney-adjusted parenteral ganciclovir per manufacturer’s instructions. Inadequate dosing is unlikely given data showing that in solid organ transplant recipients with advanced kidney dysfunction, manufacturer’s recommended dosing results in relative drug overexposure, not underexposure.4 Excluding these 2 cases, the odds of CMV disease by 12 months (0.46 [95% CI, 0.191-1.05]; P = .08) and delayed-onset CMV disease (0.30 [95% CI, 0.11-0.82]; P = .01) still favored preemptive therapy vs prophylaxis.