Combination Prophylaxis with Ganciclovir and Cytomegalovirus (CMV) Immune Globulin After Lung Transplantation: Effective CMV Prevention Following Daclizumab Induction

Weill, David; Lock, Brion J.; Wewers, Donavon L.; Young, K. Randall; Zorn, George L.; Early, L.; Kirklin, James K.; McGiffin, David C.

doi:10.1034/j.1600-6143.2003.00074.x

Cited by 53 publications

(36 citation statements)

References 12 publications

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“…Several prophylactic regimens have been studied in lung transplant recipients, including i.v. and oral GCV alone or in combination with CMV hyperimmune globulin (CMV-IVIG) (7)(8)(9)(10)(11)(12). However, the optimal prophylactic strategy in lung transplant recipients remains controversial; the appropriate regimen and duration of therapy remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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Following Universal Prophylaxis with Intravenous Ganciclovir and Cytomegalovirus Immune Globulin, Valganciclovir is Safe and Effective for Prevention of CMV Infection Following Lung Transplantation

Zamora¹,

Nicolls

Hodges

et al. 2004

American Journal of Transplantation

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144

110

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We prospectively determined the safety and efficacy of valganciclovir for prevention of cytomegalovirus (CMV) in at-risk (donor positive/recipient negative [D+/R−] or R+) lung transplant recipients. We also determined the length of prophylaxis required to significantly decrease both CMV infection and disease. Consecutive lung transplant recipients surviving >30 days (n = 90) received combination prophylaxis with intravenous (i.v.) ganciclovir (GCV) 5 mg/kg/day and cytomegalovirus immune globulin (CMV-IVIG) followed by valganciclovir (450 mg twice-daily) to complete 180, 270 or 365 days of prophylaxis. This group was compared to a historical group (n = 140) who received high-dose oral acyclovir following i.v. GCV and CMV-IVIG. CMV disease was significantly lower in patients receiving valganciclovir compared to acyclovir (2.2% vs. 20%; p < 0.0001). Freedom from CMV infection and disease was significantly greater (p < 0.02) in patients receiving 180, 270 or 365 days of prophylaxis (90%, 95% and 90%, respectively) compared to those receiving 100-179 days (64%) or <100 days (59%). No patient receiving valganciclovir died during the study. Following prophylaxis with i.v. GCV and CMV-IVIG, valganciclovir is safe and effective for prevention of CMV infection and disease in at-risk lung transplant recipients. The required length of prophylaxis was at least 180 days.

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Section: Introductionmentioning

confidence: 99%

“…We and others (4,7) have previously shown that universal prophylaxis incorporating a combination therapy with i.v. GCV and CMV-IVIG followed by high-dose oral acyclovir on post-transplant day 180, decreases the incidence of CMV and delays its onset in lung transplant recipients.…”

Section: Introductionmentioning

confidence: 99%

Following Universal Prophylaxis with Intravenous Ganciclovir and Cytomegalovirus Immune Globulin, Valganciclovir is Safe and Effective for Prevention of CMV Infection Following Lung Transplantation

Zamora¹,

Nicolls

Hodges

et al. 2004

American Journal of Transplantation

Self Cite

144

110

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show abstract

“…The optimal preventive regimen against CMV infection following lung transplantation remains undefined, but most programs employ universal antiviral prophylaxis (2). Most prophylaxis studies in lung transplant recipients have employed ganciclovir, alone or in combination with CMV hyperimmunoglobulin G (3)(4)(5)(6)(7)(8)(9)(10). Valganciclovir, an oral prodrug that achieves ganciclovir concentrations comparable to those of intravenous (i.v.)…”

mentioning

confidence: 99%

Ganciclovir-Resistant Cytomegalovirus Infections among Lung Transplant Recipients Are Associated with Poor Outcomes despite Treatment with Foscarnet-Containing Regimens

Minces

Nguyen

Mitsani

et al. 2014

Antimicrob Agents Chemother

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Ganciclovir-resistant cytomegalovirus (CMV) infections are reported infrequently among lung transplant recipients receiving extended valganciclovir prophylaxis. We performed a single-center, retrospective review of ganciclovir-resistant CMV infections in a program that employed valganciclovir prophylaxis for >6 months after lung transplant. CMV infections were diagnosed in 28% (170/607) of patients. UL97 mutations were detected in 9.4% ( The median whole-blood CMV load was 4.13 log 10 copies/cm 3 (range, 2.54 to 5.53), and 93% (14/15) of patients had low-moderate immune responses (Cylex Immunoknow). Antiviral therapy was successful, failed, or eradicated viremia followed by relapse in 12% (2/16), 31% (5/16), and 56% (9/16) of patients, respectively. Eighty-seven percent (14/16) of patients were treated with foscarnet-containing regimens; toxicity developed in 78% (11/14) of these. Median viral load half-life and time to viremia eradication among foscarnet-treated patients were 2.6 and 23 days, respectively, and did not correlate with protection from relapse. Sixty-nine percent (11/16) of patients developed CMV pneumonitis, and 25% (4/16) died of it. Serum viral load was independently associated with death among foscarnet-treated patients (P ‫؍‬ 0.04). In conclusion, ganciclovir-resistant CMV infections remained a major cause of morbidity and mortality following lung transplantation. Foscarnet-based regimens often eradicated viremia rapidly but were ineffective in the long term and limited by toxicity.

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“…Also hyperimmunoglobulin in combination with ganciclovir has been used in certain patient groups, e.g. lung transplant recipients (Weill et al, 2003).…”

Section: Prophylaxismentioning

confidence: 99%

Drug Resistance due to Mutation in UL 97 and Certain Other Specific Genes in Cytomegalovirus Strains: An Overview

Kumar¹

2013

IOSR-JPBS

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Combination Prophylaxis with Ganciclovir and Cytomegalovirus (CMV) Immune Globulin After Lung Transplantation: Effective CMV Prevention Following Daclizumab Induction

Cited by 53 publications

References 12 publications

Following Universal Prophylaxis with Intravenous Ganciclovir and Cytomegalovirus Immune Globulin, Valganciclovir is Safe and Effective for Prevention of CMV Infection Following Lung Transplantation

Following Universal Prophylaxis with Intravenous Ganciclovir and Cytomegalovirus Immune Globulin, Valganciclovir is Safe and Effective for Prevention of CMV Infection Following Lung Transplantation

Ganciclovir-Resistant Cytomegalovirus Infections among Lung Transplant Recipients Are Associated with Poor Outcomes despite Treatment with Foscarnet-Containing Regimens

Drug Resistance due to Mutation in UL 97 and Certain Other Specific Genes in Cytomegalovirus Strains: An Overview

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