Late-Onset Cytomegalovirus (CMV) in Lung Transplant Recipients: Can CMV Serostatus Guide the Duration of Prophylaxis?

Abstract

Evidence supports the use of 12 months of cytomegalovirus prophylaxis in all at-risk lung transplants; whether cytomegalovirus serostatus can be used to further optimize this duration remains to be determined. The purpose of this retrospective study was to determine if cytomegalovirus serostatus of both donor and recipient were associated with lateonset cytomegalovirus. The primary outcome was the proportion of lung transplants that developed cytomegalovirus infection or disease during the 180-day period following 6 months of prophylaxis in each at-risk serotype. Two hundred forty-four consecutive lung transplants were evaluated, 131 were included.

Treatment and prevention of cytomegalovirus infection in heart and lung transplantation: an update

“…of D+/R+ and only 6% of D-/R+ developed infection or disease 108 , while in heart recipients prolonged prophylaxis with the addition of CMV-Ig preparations is associated to lower CMVrelated outcomes in D+/R-when compared to R+ patients receiving a short course of prophylaxis.…”

Updated International Consensus Guidelines on the Management of Cytomegalovirus in Solid-Organ Transplantation

“…Although some centers have successfully used half the recommended dose of valganciclovir for prophylaxis (i.e., 450 mg daily in patients with normal renal function, sometimes called ''mini-dosing'') based on pharmacokinetic equivalence to 3 g daily of oral ganciclovir and also to minimize toxicity and cost of prophylaxis, there are insufficient data to support the routine use of such dosing (weak, low). Such an approach may convey more risk with D+/R-, who are at higher risk for breakthrough disease (156) and development of resistance. Future prospective studies are required to determine the efficacy of lower dose valganciclovir.…”

“…In R+ lung transplant recipients, a minimum of 6 months prophylaxis recommended (strong, moderate). Serostatus at the time of transplantation may help guide the duration of prophylaxis; after 6 months of prophylaxis after lung transplantation, 34% of D+/R+ and only 6% of D-/R+ developed infection or disease (156). & Although D+/R+ patients are discussed here together with the D-/R+ group, the former group is typically at higher risk for developing CMV disease (124,156).…”

“…Compared with extended prophylaxis, short duration (3 months) prophylaxis is associated with increased CMV infection and disease (155). In a recent study of 6 months of prophylaxis, almost 50% of D+/R-lung transplant patients developed late-onset CMV infection or disease: 29% developed CMV infection and 20% developed CMV disease (156), again suggesting longer prophylaxis may be warranted. & A minimum of 6 months of prophylaxis is recommended for D+/R-vascularized composite (i.e., hand and face) and intestinal transplant recipients (weak, low).…”

CMV management in lung transplant recipients

“…Recent Guidelines in CMV management of Solid Organ Transplantations (82) suggest at least that R+ lung transplant recipients, a minimum of 6 months prophylaxis recommended (strong, moderate). Serostatus at the time of transplantation may help to guide the duration of prophylaxis; after 6 months of prophylaxis after lung transplantation, 34% of D+/R+ and only 6% of D-/R+ developed infection or disease (83). Although D+/R+ patients are discussed here together with the D-/R+ group, the former group is typically at higher risk for developing CMV disease (84).…”