Cytomegalovirus Infection and Pneumonitis: Impact after Isolated Lung Transplantation

Abstract

Using aggressive surveillance of blood, bronchoalveolar lavage (BAL) fluid, and lung tissue, we sought to determine the incidence of cytomegalovirus (CMV) pneumonitis in isolated lung transplant recipients and to characterize its impact on pulmonary function, chronic rejection, and survival. Forty-six lung transplant recipients who survived greater than 30 days had prospective documentation of CMV infection in blood and BAL fluid and regular surveillance with transbronchial lung biopsy. CMV infection was documented in 92% of patients who were D-/R+, D+/R+, or D+/R-, and the incidence of histologically confirmed CMV pneumonitis among these patients was 75%. No D-/R- patient experienced CMV infection or disease. D+/R- patients experienced more frequent and severe episodes, and ganciclovir prophylaxis during the first 2 wk was not useful. CMV pneumonitis was accompanied by detectable radiographic changes in less than one third of cases. The detection of CMV in BAL fluid was not predictive of CMV pneumonitis on biopsy, except in D+/R- patients during the first 90 days after transplantation. There was no evidence of an adverse impact because of CMV infection on pulmonary function during the first year after transplantation. A relationship between CMV infection and bronchiolitis obliterans could not be documented; however, D+/R- patients had higher morbidity and a trend toward lower survival. In a multivariate analysis, D+/R- status was an independent predictor of death.

Infection and Bronchiolitis Obliterans among Native American Lung Transplant Recipients

“…However, based on several studies, RSV appears to be an important cause of serious lower respiratory tract infections requiring hospitalization. CMV infections are generally not linked to BOS [14][15][16][17], and therefore not analyzed in this study.…”

Nachweis von Atemwegsviren – Wie, warum, wann und wo?

“…Eine Infektion mit CMV ist ein wesentlicher Grund für Morbidi− tät und Mortalität bei lungentransplantierten Patienten. Die In− zidenz von CMV wird mit 54 ± 92 % bei Patienten ohne CMV−Pro− phylaxe angegeben [78,79]. Der wichtigste Risikofaktor ist ein infizierter Spender bei seronegativem Empfänger [79].…”

“…Die In− zidenz von CMV wird mit 54 ± 92 % bei Patienten ohne CMV−Pro− phylaxe angegeben [78,79]. Der wichtigste Risikofaktor ist ein infizierter Spender bei seronegativem Empfänger [79]. Eine ver− lässliche Diagnostik ist daher von großer Bedeutung.…”

Current status of lung transplantation

“…4) [64,65]. Lung transplant recipients who are CMV-negative and receive CMV-positive donor lungs are at the greatest risk of developing severe life-threatening disease from primary infection, whereas it is not usually seen in donor-negative/ recipient-negative transplants [64].…”

“…4) [64,65]. Lung transplant recipients who are CMV-negative and receive CMV-positive donor lungs are at the greatest risk of developing severe life-threatening disease from primary infection, whereas it is not usually seen in donor-negative/ recipient-negative transplants [64]. In these high-risk patients, 60s the present authors routinely administer prophylactic treatment consisting of 12 weeks of intravenous ganciclovir (5 mg?kg body weight -1 daily), usually starting 7-14 days after transplantation.…”