Successful treatment with ganciclovir of disseminated cytomegalovirus infection after liver transplantation.

Disseminated cytomegalovirus (CMV) infection in a liver transplant recipient was treated successfully by administration of ganciclovir (BW B759U) at a dosage of 7.5 mg/kg/day for 2 wk in the face of continuation of chemical immunosuppression. The spectrum of illness included symptomatic esophagitis and hepatic dysfunction associated with the appearance of CMV inclusion bodies, retinal lesions, and bone marrow suppression. Clinical improvement during therapy with ganciclovir was prompt and was paralleled by reversal of histological abnormalities. CMV was recovered from none of the cultured tissues after the start of therapy. Ten months after discontinuation of ganciclovir, the patient had no evidence of further CMV disease. The observation suggests that replicative CMV infection in organ-transplanted patients may be suppressed by relatively low dose ganciclovir, even when the patients are maintained on immunosuppressive regimens designed to prevent graft rejection.