Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Pharmacokinetics of ganciclovir in renal transplant children

  • 44 Accesses

  • 12 Citations

Abstract

Three cytomegalovirus (CMV)-seronegative children received renal transplants from CMV-seropositive donors and developed clinical symptoms of CMV infection between days 20 and 34 post transplantation. Ganciclovir (DHPG) was administered in a 1-h infusion, and the doses and dose intervals were adapted to the degree of renal insufficiency, according to the manufacturer's recommendations for adults. Individual pharmacokinetic parameters of DHPG were determined and were markedly altered. Plasma clearances were 0.4, 1.1 and 2.2 ml/min per kg and were related to individual creatinine clearances (20, 45 and 60 ml/min per 1.73 m2); the corresponding elimination half-lives were 23.7, 9.9 and 3.9 h. In two patients, the doses had to be further reduced in order to maintain plasma levels within the recommended values for peak and trough plasma concentrations. Therefore, monitoring of DHPG appears essential in adjusting dosage for optimal efficacy and minimal toxicity.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Rubin RH (1990) Impact of cytomegalovirus infection on organ transplant recipients. Rev Infect Dis 12 [Suppl 7]: S754-S766

  2. 2.

    Laskin OL, Cederberg DM, Mills J, Eron LJ, Mildvan D, Spector SA (1987) Ganciclovir for the treatment and suppression of serious infections caused by cytomegalovirus. Am J Med 83: 201–207

  3. 3.

    Plotkin SA, Drew WL, Felsenstein D, Hirsch MS (1985) Sensitivity of clinical isolates of human cytomegalovirus to 9-(1,3-dihydroxy-2-propoxymethyl)guanine. J Infect Dis 152: 833–839

  4. 4.

    Fletcher C, Sawchuk R, Chinnock B, Miranda P de, Balfour HH Jr (1986) Human pharmacokinetics of the antiviral drug DHPG. Clin Pharmacol Ther 40: 281–286

  5. 5.

    Ho M (1990) Epidemiology of cytomegalovirus infections. Rev Infect Dis 12 [Suppl 7]: S701-S710

  6. 6.

    Rubin RH, Tolkoff-Rubin NE, Oliver D, Rota TR, Hamilton J, Betts RF, Pass RF, Hillis W, Szumuness W, Farrell ML, Hirsch MS (1985) Multicenter seroepidemiologic study of the impact of cytomegalovirus infection on renal transplantation. Transplantation 40: 243–249

  7. 7.

    Peterson PK, Balfour HH Jr, Marker SC, Fryd DS, Howard RJ, Simmons RL (1980) Cytomegalovirus disease in renal allograft recipients: a prospective study of the clinical features, risk factors and impact on renal transplantation. Medicine (Baltimore) 59: 283–300

  8. 8.

    Dunn DI, Mayoral JL, Gillinghan KJ, Loeffler CM, Brayman KL, Kramer MA, Erico A, Balfour HH Jr, Fletcher CV, Bolman R III, Matas AJ, Payne WD, Sutherland DER, Najarian JS (1991) Treatment of invasive cytomegalovirus disease in solid organ transplant patients with ganciclovir. Transplantation 51: 98–105

  9. 9.

    Snydman DR, Werner BG, Heinze-Lacey B, Berardi VP, Tilney NL, Kirkman RL, Milford EL, Cho SI, Bush HL Jr, Levey AS, Strom TB, Carpenter CB, Levey RH, Harmon WE, Zimmerman CE II, Shapiro ME, Steinman T, Logerfo F, Iselson B, Schroter, Levin MJ, McIver J, Leszczynski J, Grady GF (1987) Use of cytomegalovirus immune globulin to prevent cytomegalovirus disease in renal transplant recipients. N Engl J Med 317: 1049–1054

  10. 10.

    Snydman DR, Werner BG, Tilney NL, Kirkman RI, Milford EL, Cho SI, Bush HL Jr, Levey AS, Strom TB, Carpenter CB, Berardi V, Levey R, Harmon WE, Zimmerman CE II, Tenny A, Heinze-Lacey B, Shapiro ME, Steinman T, Logerfo F, Idelson B, McIver J, Leszczynski J, Grady GF (1988) A further analysis of primary cytomegalovirus disease prevention in renal transplant recipients with a cytomegalovirus immune globulin: interim comparison of a randomized and open-label trial. Transplant Proc 20 [Suppl 8]: 24–30

  11. 11.

    Balfour HH Jr, Chase BA, Stapleton JT, Simmons RL, Fryd DS (1989) A randomized placebo-controlled trial of oral acyclovir for the prevention of cytomegalovirus disease in recipients of renal allografts. N Engl J Med 320: 1381–1387

  12. 12.

    Collaborative DHPG treatment study group (1986) Treatment of serious cytomegalovirus infections with 9-(1,3 dihydro-2-propoxymethyl)guanine in patients with AIDS and other immunodeficiencies. N Engl J Med 314: 801–805

  13. 13.

    Gudnason T, Belani KK, Balfour HH Jr (1989) Ganciclovir treatment of cytomegalovirus disease in immunocompromised children. Pediatr Infect Dis J 8: 436–440

  14. 14.

    Balfour HH Jr (1990) Management of cytomegalovirus disease with antiviral drugs. Rev Infect Dis 12 [Suppl 7]: S849-S860

  15. 15.

    Sommadossi JP, Bevan R, Ling T Lee F, Mastre B, Chaplin MD, Nerenberg C, Koretz S, Buhles WC Jr (1988) Clinical pharmacokinetics of gancilovir in patients with normal and impaired renal function. Rev Infect Dis 10 [Suppl 3]: S507-S514

Download references

Author information

Correspondence to Evelyne Jacqz-Aigrain.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Jacqz-Aigrain, E., Macher, M.A., Sauvageon-Marthe, H. et al. Pharmacokinetics of ganciclovir in renal transplant children. Pediatr Nephrol 6, 194–196 (1992). https://doi.org/10.1007/BF00866315

Download citation

Key words

  • Renal transplant
  • Renal insufficiency
  • Cytomegalovirus
  • Ganciclovir
  • Pharmacokinetics