Combined CMV Prophylaxis Improves Outcome and Reduces the Risk for Bronchiolitis Obliterans Syndrome (BOS) after Lung Transplantation

Ruttmann, Elfriede; Geltner, Christian; Bucher, Brigitte; Ulmer, Hanno; Höfer, Daniel; Hangler, Herbert; Semsroth, Severin; Margreiter, Raimund; Laufer, Günther; Müller, Ludwig

doi:10.1097/01.tp.0000209439.27719.ed

Cited by 95 publications

(70 citation statements)

References 23 publications

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“…In fact, several studies have reported the successful prevention of CMV disease in high-risk transplant recipients using passive immunization [26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Association of the Outcome of Renal Transplantation with Antibody Response to Cytomegalovirus Strain--Specific Glycoprotein H Epitopes

Ishibashi

Tokumoto

Tanabe

et al. 2007

Clinical Infectious Diseases

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Background. Cytomegalovirus (CMV) is the most important pathogen affecting the outcome of renal transplantation. The combination of CMV-seronegative transplant recipients with CMV-seropositive transplant donors places recipients at the highest risk of CMV disease. In cases of congenital CMV infection, existing immunity only partially protected mothers from reinfection with a different genotypic strain. The effect of differences in infected CMV strains between CMV-seropositive transplant donors and CMV seropositive transplant recipients on the outcome of transplantation remains unclear.Methods. In this prospective multicenter study, the presence of antibodies against strain-specific glycoprotein H epitopes in 84 CMV-seropositive transplant donor/CMV-seropositive transplant recipient renal transplantation cases were determined, and their relationships to acute transplant rejection, CMV infection, degree of antigenemia, and CMV disease were evaluated.Results. Among the 84 donor/recipient pairs, 45 and 32 had matched and mismatched strain-specific glycoprotein H antibodies, respectively. Acute transplant rejection in the mismatched group was more frequent than it was in the matched group (63% vs. 22%;). CMV disease was also more frequently observed in the P p .005 mismatched group (28% vs. 9%;). The mismatched group had a higher level of antigenemia ( P p .026 P p ). .019Conclusions. Our results illustrate more adverse events in the cases with a CMV-seropositive transplant donor and a CMV-seropositive transplant recipient in which the glycoprotein H antibodies are mismatched, suggesting that reinfection with a different CMV strain results in more complications.

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“…In fact, several studies have reported the successful prevention of CMV disease in high-risk transplant recipients using passive immunization [26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Association of the Outcome of Renal Transplantation with Antibody Response to Cytomegalovirus Strain--Specific Glycoprotein H Epitopes

Ishibashi

Tokumoto

Tanabe

et al. 2007

Clinical Infectious Diseases

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“…Monotherapy with IV GCV has clearly delayed the incidence of CMV infection, disease and subsequent BOS. 6 -8 Combination therapy with IV ganciclovir and CMV-IVIg for short-term prophylaxis further reduces the incidence of CMV disease 9,10 and was recently demonstrated by Ruttman et al 11 to improve rates of CMV disease, 3-year freedom from BOS and survival in high-risk allograft recipients of CMV-positive donors. A study by Zamora et al 12 further showed protracted therapy with valganciclovir for at least 6 months and up to 1 year reduces incidence of CMV disease to as low as 2.3% in CMV-seronegative LTRs of CMV-positive donors.…”

mentioning

confidence: 94%

Ganciclovir for Cytomegalovirus: a Call for Indefinite Prophylaxis in Lung Transplantation

Valentine

Weill

Gupta

et al. 2008

The Journal of Heart and Lung Transplantation

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“…Most immunosuppressive and anti-infective drugs have only been proven for safety and efficacy in kidney or liver transplant recipients. Therefore, no clear recommendations concerning prophylactic regimen and dosage in cardiothoracic transplantation are available from the companies distributing CMV-IG (19,20). In the following pages we'll try to review the role CMV on lung transplantation and the possible best approach to its management.…”

Section: Introductionmentioning

confidence: 99%

CMV management in lung transplant recipients

Solidoro¹,

Costa²,

Libertucci³

et al. 2014

sob

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recipients management relative to the mortality and morbidity and, on the other hand, to the availability of effective antiviral agents as well as new diagnostic techniques and the prophylaxis, diagnosis, and treatment of CMV infections. In lung transplant recipients management is evolving with experience and we are living the sunrise of a new personalized or tailored management era matching, almost in real time, infection, diagnosis, immunity status and therapy. KEY WORDS: CMV infection, lung transplant, acute rejection, chronic rejection, hyperimmune globulins. IntroductionCytomegalovirus (CMV), a member of the beta herpes virus group, causes a spectrum of disorders, which includes serious illness in organ transplant recipients (1-4). Its presence in biological specimens and its role in co-infections and rejection is far to be fully defined. It is the second most common infection among lung transplant recipients, after bacterial pneumonia (5, 6), and is associated with significant morbidity and mortality after transplantation. Although the availability of effective antiviral drugs has decreased CMV-related mortality, the attention in last years has been addressed to its immunobiological role: in fact CMV infections or pneumonia have been associated to chronic rejection (bronchiolitis obliterans syndrome, BOS) in some, but not all, studies (7,8). The endothelium represents the anatomical and functional interface between engrafted donor tissue and the host immune system and interacts dynamically in immunomodulation. This implies an important role for the endothelial cell (EC) in the initiation, maintenance and/or termination of immune interactions affecting the fate of allograft (9). CMV does not directly induce HLA class II on infected human EC, but the rejection associated class II induction within the allograft might be a consequence of IFN-gamma release by activated T CD4+ cells in response to CMV infection (10).

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Combined CMV Prophylaxis Improves Outcome and Reduces the Risk for Bronchiolitis Obliterans Syndrome (BOS) after Lung Transplantation

Abstract: In CMV high risk patients, additional CMV-IG administration seems to be effective to reduce CMV-related morbidity and to avoid CMV-related mortality. Reduced incidence of BOS may result from improved CMV prevention, although randomized trials are warranted.

Cited by 95 publications

References 23 publications

Association of the Outcome of Renal Transplantation with Antibody Response to Cytomegalovirus Strain--Specific Glycoprotein H Epitopes

Association of the Outcome of Renal Transplantation with Antibody Response to Cytomegalovirus Strain--Specific Glycoprotein H Epitopes

Ganciclovir for Cytomegalovirus: a Call for Indefinite Prophylaxis in Lung Transplantation

CMV management in lung transplant recipients

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