Cytomegalovirus (CMV) infection is generally diagnosed by the antigenemia method in Japan. CMV infection frequently occurs within 3 months after renal transplantation. Therefore, antigenemia should be studied once a week or 2 weeks within 3 months of postrenal transplantation. The standard level of positive cells depends on the renal transplant center; however, the high-risk recipients, irrespective of being asymptomatic, should be treated as soon as a positive cell appears. In particular, a CMV seronegative recipient transplanted from a seropositive donor tends to suffer from serious infection and disease as a primary infection. In such a case, valganciclovir (VGCV) is prophylactically administered for 3 months postrenal transplantation abroad. Preemptive treatment is preferred in most Japanese renal transplant centers because prophylactic use of VGCV is not covered by medical insurance in Japan. Ganciclovir (GCV) should be intravenously administered at first if a recipient is seriously symptomatic with positive antigenemia. The dose and term of VGCV and GCV are decided in terms of renal function.
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