Cytomegalovirus viremia in lung transplantation during and after prophylaxis

Abstract

Background Lung transplantation has a high risk of cytomegalovirus (CMV) viremia and disease. Methods Valganciclovir was planned for 6 months in CMV recipient seropositive (R+) lung transplants (LTs) and given long‐term in D+R− LTs. CMV viremia was monitored regularly during and after prophylaxis in all patients. Results Of 137 LTs, 22 were D+R−, 49 D+R+, 43 D−R+, and 23 D−R−, with median follow up 4.1 years (IQR 2.1‐6.2 years). CMV viremia at any time occurred in 44.5% of LTs. CMV viral load >103 c/mL was uncommon (9/77 episodes). CMV viremia occurred at median 665 days (IQR 271‐1411 days), in 5.1% LTs <6 months, 20.3% LTs 6‐12 months, and 35.8% LTs >12 months. CMV disease occurred in 6 (4.4%) LTs at an overall rate of 1.0 episode per 100 person‐years: two of these cases were organ‐specific disease, four were CMV syndrome. One case of ganciclovir‐resistant CMV was diagnosed. D+R+ and D+R− LTs had higher viremia rates than the D−R+ group. No viremia occurred in D−R− LTs. CMV viremia was not associated with age, gender, type of LT, indication for LT, acute rejection, bronchiolitis obliterans syndrome, or mortality. Conclusions Prophylaxis for 6 months in D+R+ and D−R+, and past 12 months in D+R− LTs, with long‐term monitoring in all patients using a sensitive assay, and reinstitution of valganciclovir for low‐level viremia was effective at markedly reducing the incidence of CMV disease. CMV D−R− LTs do not need routine CMV monitoring.

Trends and Outcomes in Lung Transplantation in Patients with and without Idiopathic Pulmonary Fibrosis in Spain during the Period 2016–2020

“…Additionally, of these, only one patient had pneumonia [46]. On the other hand, cytomegalovirus infections have decreased in frequency to date, possibly because of specific prophylaxis [47].…”

Aspectos do uso de agentes profiláticos em infecções fúngicas resultantes de transplante pulmonar

“…e que uma série de fatores contribuem para seu desenvolvimento. Os fatores de risco mais relatados foram: imunossupressão [11,12], colonização pré ou pós-transplante das vias aéreas [5,6,10,11,12,13,14,15,16,17], isquemia anastomótica [6,10,11], transplante unilateral [10,11,13], infecção por citomegalovírus [10,11,13,14]. Outros fatores de risco relatados foram: idade avançada [11], ambientes hospitalares contaminados [5], transfusões de mais de sete unidades de hemácias durante o transplante [6], recipientes melanodermos [6], entre outros.…”

“…Além da complexa patogênese, também contribuindo para a dificuldade, está a variável tolerabilidade dos antifúngicos pelos pacientes [5,11,14,15,16,18,19], a crescente taxa de resistência dos micro-organismos [12,14,16,3], e os frequentes altos custos [5,14,16] destes medicamentos.…”

“…Brazilian Journal of Health Review, Curitiba, v. 6, n. 5, p. 19914-19925, sep/oct., 2023 mais de um ano [5,6,10,11,12,13,14,16,18,20], demonstrando a grande variação das estratégias de prevenção a depender de onde são realizadas. O Voriconazol apresenta alta eficácia, disponibilidade intravenosa e oral e taxa de absorção confiável, portanto está entre os azólicos mais admnistrados aos pacientes [15,16].…”

“…Os níveis sanguíneos alvos avaliados foram: voriconazol (1-6 mg/L); itraconazol (>0.7 mg/L); e posaconazol (>0.7 mg/L) [11].…”