The Risk, Prevention, and Outcome of Cytomegalovirus After Pediatric Lung Transplantation

Abstract

Background A retrospective review of pediatric lung transplant recipients at 14 centers in North America and Europe was conducted to characterize the epidemiology and risk factors for cytomegalovirus (CMV) and to explore the impact of preventative antiviral therapy. Methods Data were recorded for one year post-transplant. Associations between CMV and continuous and categorical risk factors were assessed using Wilcoxon rank-sum and Chi-square tests, respectively. Associations between time to CMV and risk factors or survival were assessed by multivariable Cox proportional hazards models. Results Within 12 months posttransplant, 172 of 577 subjects (29.8%) developed 218 CMV episodes (90 asymptomatic infection, 25 syndrome, 103 disease). Forty-one subjects developed more than one episode of CMV. Donor or recipient CMV seropositivity was associated with increased risk of CMV episodes. Except for decreased prophylaxis in CMV D-/R- subjects, duration of prophylaxis did not vary by D/R serostatus. For CMV D+ subjects, not being on prophylaxis at the time of CMV episode increased the risk of CMV (D+/R+ HR 3.5: 95% CI 1.4, 8.4; D+/R- 1.9: 1.02, 3.7). CMV was associated with increased mortality within the first posttransplant year among those with donor or recipient CMV seropositivity (HR 2.0: 95% CI 1.1, 3.6; p=0.024). Conclusions CMV remains a serious complication after pediatric lung transplant, and the impact of prophylaxis is complex.

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

“…The incidence of CMV DNAemia after pediatric renal transplantation is approximately 20%, with disease in 3% to 10% (219,220). CMV was detected in the blood in 29% to 32% of pediatric lung transplant recipients in the first year, with CMV pneumonitis in 20% (221,222).…”

“…In addition, CMV D-/R-pediatric SOT recipients have a greater risk of acquiring de novo CMV infection from community exposures. As many as 7% of pediatric CMV D-/Rrecipients developed primary CMV infection in the first year after transplantation (222). Characterizing donor and recipient serostatus for children younger than 12 months is confounded by the potential presence of maternal CMV antibodies acquired transplacentally.…”

Isolation of Aspergillus species from the airway of lung transplant recipients is associated with excess mortality

“…CMV donor or recipient seropositive lung allograft patients are at increased risk of acquiring and succumbing to CMV infection. 23 These associations may explain the relationship between CMV seropositivity and survival in our cohort. Episodes of CMV infection for patients were not recorded as part of this study and we are, therefore, unable to further explore the potential association between CMV infection and survival.…”

“…7 A number of authors have examined cohorts of lung transplant patients in order to identify risk factors for invasive fungal infections (IFI). 3,5,7,12,23 The majority of these studies have been retrospective in design, had low statistical power, have assessed different endpoints and have produced conflicting results. Comparison of risk factors identified in published studies is difficult due to disparity in study end-points and study design.…”

Tata laksana Infeksi Sitomegalovirus pada Pasien Transplantasi Organ Padat

“…Akan tetapi, viremia masih berhubungan dengan meningkatnya kematian dan retransplantasi pada anak resipien transplantasi paru. 37 Terapi gansiklovir intravena diberikan bersamaan dengan berkurangnya penggunaan imunosupresan, kecuali jika ada bukti terjadinya rejeksi. Respons klinis akan dijumpai dalam 5-7 hari.…”