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Severe bone marrow failure due to valganciclovir overdose after renal transplantation from cadaveric donors: four consecutive cases.

Abstract：

:Valganciclovir is an l-valyl ester pro-drug of ganciclovir that was initially used to treat cytomegalovirus (CMV)-associated retinitis in patients with human immunodeficiency virus. Currently, it is also indicated for the prevention of CMV disease in solid-organ transplantation. It is primarily eliminated via the kidneys through glomerular filtration and tubular secretion. Decreased renal function results in decreased drug clearance. Valganciclovir has been reported to cause usually mild to moderate hematologic adverse effects such as leukopenia, neutropenia, anemia, thrombocytopenia, and pancytopenia. Severe and fatal bone marrow depression has been described in 1 adult patient. Herein, we describe the cases of 4 patients with end-stage renal disease who underwent cadaveric renal transplantation and received valganciclovir prophylaxis for CMV at a standard dose of 900 mg/d despite persistant renal failure. This therapy resulted in severe bone marrow failure after 18 to 20 days in all 4 patients, with fatal infections in 2 patients. This report demonstrates the in vivo pharmacodynamics of valganciclovir overdose in terms of hematotoxicity in the setting of renal impairment. Valganciclovir, as its derivative ganciclovir, should be used cautiously in patients with renal impairment.

journal_name

Transplant Proc

journal_title

Transplantation proceedings

authors

Ar MC,Ozbalak M,Tuzuner N,Bekoz H,Ozer O,Ugurlu K,Tabak F,Ferhanoglu B

doi

10.1016/j.transproceed.2009.02.093

subject

Has Abstract

pub_date

2009-06-01 00:00:00

pages

1648-53

issue

5

eissn

0041-1345

issn

1873-2623

pii

S0041-1345(09)00444-8

journal_volume

41

pub_type

杂志文章

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