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A meta-analysis of 12 randomized trials (1574 patients) examined herpesvirus and related outcomes following organ transplantation over a range of acyclovir exposures (including valacyclovir). Overall, cytomegalovirus (CMV) infection (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.34-0.57; P&lt;.001), CMV disease (OR, 0.41; 95% CI, 0.31-0.54; P&lt;.001), death (OR, 0.60; 95% CI, 0.40-0.90; P=.01), opportunistic infection (OR, 0.70; 95% CI, 0.53-0.91; P=.009), acute graft rejection (OR, 0.67; 95% CI, 0.52-0.86; P&lt;.001), herpes simplex virus disease (OR, 0.17; 95% CI, 0.12-0.24; P&lt;.001), and varicella-zoster virus disease (OR, 0.06; 95% CI, 0.01-0.25; P&lt;.001) were significantly reduced. Increased acyclovir exposure influenced more end points: Maximum efficacy resulted from valacyclovir (8 g/day). Increasing acyclovir exposure to that achieved with valacyclovir extends benefits of prophylaxis to include impact on graft rejection and opportunistic infections.

Valacyclovir Provides Optimum Acyclovir Exposure for Prevention of Cytomegalovirus and Related Outcomes after Organ Transplantation