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Diabetics who undergo pancreas alone (PA) or simultaneous kidney/pancreas transplant (SKP) have an increased risk of CMV disease due to a higher proportion of CMV antibody negative patients in this population and the need for more potent immunosuppressive regimens. The overall efficacy and appropriate dosing regimen of oral ganciclovir remains controversial due to the poor absorption of this formulation. A consecutive cohort of patients undergoing PA or SKP transplants were retrospectively reviewed wine a cross-sectional study design with groups divided based on date of transplant. Patients receiving PA & SKP transplants between January 1995 and May 1996 received ganciclovir (CAN) 5 mg/kg IV Q12H continued until discharge after transplant followed by oral acyclovir (ACY) 400 mg TID. Patients between June 1996 and June 1997 received IV GAN 5 mg/kg Ql2H until discharge followed by oral GAN 1000 mg TID. All patients were monitored for CMV disease until November 1, 1997. CMV disease was defined as a combination of leukopenia, thrombocytopenia, four-fold increase in CMV titers either with or without evidence of biopsy proven tissue invasive CMV infection All hospitalizations of CMV disease were coded. The total cost of CMV disease was calculated by assessing the cost of the prophylaxis regimen and hospital charges for the target endpoint of CMV disease. Basic demographics were similar in both groups. The ACY group experienced more antilymphocyte induction treatment (95% vs. 25%). More patients in the GAN group were maintained on mycophenolate mofetil when compared to the ACY -group (100% vs. 23%). Twenty-two patients in the ACY group experienced 13 episodes (59%) of CMV disease, and the GAN group included thirty-one patients who suffered 4 episodes (13%) of CMV disease (p<0.01). The average follow-up time in the ACY group was 24.5 months, and the average follow-up time in the GAN group was 9.4 months. The cost for CMV disease per patient, based upon incorporation of costs for CMV prophylaxis and CMV disease admissions, was $15,529 in the ACY group and $10,015 in the GAN group. An overall cost savings of approximately $5,000 per patient was realized for patients maintained on oral ganciclovir. Ganciclovir provides superior prophylaxis after IV ganciclovir when compared to acyclovir in PA and SPK transplant patients. The increased acquisition costs of oral ganciclovir can be countered by decreased hos[pitalization and inpatient charges