Delay of CMV infection in high‐risk CMV mismatch lung transplant recipients due to prophylaxis with oral ganciclovir

Abstract

Cytomegalovirus (CMV) is a common opportunistic infection in lung transplant recipients. Despite the use of early post-operative intravenous ganciclovir, most high-risk patients develop CMV infection. We conducted this retrospective study to determine the efficacy of extended CMV prophylaxis with oral ganciclovir in high-risk, donor-positive-recipient-negative, lung recipients. All patients initially received 3 months of intravenous ganciclovir and CMV hyperimmune globulin. Clinical outcomes in all CMV mismatch patients undergoing lung transplant surviving at least 3 months were included (n = 42). Since 1998, 14 patients received no oral ganciclovir prophylaxis (group 1) and 28 patients received indefinite oral ganciclovir after completion of intravenous therapy (group 2). In those patients receiving oral ganciclovir, the prevalence of post-transplant CMV infection was significantly reduced over the first 180 d post-transplant (50% in group 1 vs. 4% in group 2; p < 0.001). Although some CMV events were observed with additional follow-up in group 2, there remained a significantly greater freedom from CMV infection by Kaplan-Meier analysis in group 2 as compared with group 1, with over 30 months follow-up time in each group (log-rank, p = 0.02). A moderate rate of drug discontinuation was observed in group 2, and no severe drug-related events occurred. In high-risk lung transplant recipients, CMV prophylaxis with intravenous ganciclovir, followed by indefinite oral ganciclovir, significantly delays and reduces post-transplant CMV infections. A larger prospective randomized study is needed to confirm the benefits of oral ganciclovir on CMV prevention.

A Multicenter Study of Valganciclovir Prophylaxis up to Day 120 in CMV-Seropositive Lung Transplant Recipients

“…Moreover, with this type of prophylaxis, there is a nearly 10% rate of ganciclovir-resistant infection (8,10). The reported incidence of CMV disease with oral ganciclovir is around 30% (7,15), whereas in the present study it was 16.1%. …”

Cytomegalovirus Pneumonitis Is a Risk for Bronchiolitis Obliterans Syndrome in Lung Transplantation

“…Small retrospective studies indicated that routine use of ganciclovir for CMV prophylaxis perioperatively decreased CMV disease and delayed the onset of BOS as compared with no prophylaxis (5,6). Consequently, most lung transplantation centers routinely employ a fixed duration of intravenous ganciclovir and/or oral valganciclovir prophylaxis immediately after transplantation.…”

Ganciclovir/Valganciclovir Prophylaxis Decreases Cytomegalovirus-Related Events and Bronchiolitis Obliterans Syndrome after Lung Transplantation

“…To support the relevance of the outcome in our small control population, we performed an exhaustive search of the Medline database and compiled all available articles that contained a full data set for patients who underwent lung transplantation ( ) during 1982-1999 n p 274 and who had not received CMV prophylaxis. Data with respect to the incidence of CMV-related events and disease from 4 observational studies [1][2][3][4] and from the historical control subjects of 5 nonrandomized trials of ganciclovir prophylaxis [5][6][7][8][9] were compared with data from the current series. With respect to BOS and survival, data were available for only 139 cases reported in the literature [4,5,8,9].…”