Preemptive Ganciclovir Therapy in Renal Transplantation

Daniel C. Brennan; Gregory A. Storch; Bruce J. Lippman

doi:10.7326/0003-4819-124-7-199604010-00015

Letters |1 April 1996

Preemptive Ganciclovir Therapy in Renal Transplantation

Daniel C. Brennan, MD; Gregory A. Storch, MD; Bruce J. Lippman, MD

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TO THE EDITOR:

Hibberd and colleagues [1] recently showed that administration of ganciclovir during antilymphocyte therapy in renal transplant recipients who tested positive for cytomegalovirus (CMV) antibody decreased the incidence of CMV disease. They called this treatment strategy “preemptive therapy.” We believe that a more accurate term would have been “selected prophylactic therapy.”

The term “prophylaxis” connotes the use of an agent to prevent disease in patients at risk when no evidence suggests the imminent development of that disease. Thus, we use antibiotics for endocarditis prophylaxis when a patient with a heart murmur (but no overt evidence of bacteremia) has an invasive procedure. The term “preemptive” is most often used in military parlance when the risk for an event is imminent or in the early stages of development. For example, a “preemptive strike” was used against the Iraqis during the Persian Gulf war when military surveillance identified the presence of missile sites. A “prophylactic strike” would have been one in which all the Iraqi machine factories were attacked because they had the capability of missile production, although no missiles had been detected. Truly preemptive therapy for CMV has already been shown to be useful in bone marrow transplant recipients who began receiving ganciclovir early on the basis of detection of CMV excretion by culture of throat swabs, blood, urine, or bronchoalveolar lavage fluid [2, 3].

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Letters |1 April 1996

Preemptive Ganciclovir Therapy in Renal Transplantation

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Letters |1 April 1996

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