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

Potena, Luciano; Solidoro, Paolo; Patrucco, Filippo; Borgese, L.

doi:10.1080/14656566.2016.1199684

Cited by 29 publications

(17 citation statements)

References 113 publications

(117 reference statements)

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“…In fact, in all cases the first CMV DNAemia detection occurred after the discontinuation of prophylactic therapy (at a median time of 58 days posttransplant), while all preemptively managed patients experienced CMV infection in the early posttransplant period (i.e., within 1 month posttransplant). These findings are in accordance with those reported by other authors (3,13). However, to date there have not been any published randomized trials that directly compared preemptive therapy and prophylaxis in nonrenal solid-organ transplant recipients and there are no available reports of studies that clearly indicate which strategy is superior (3,13).…”

Section: Discussionsupporting

confidence: 92%

“…These findings are in accordance with those reported by other authors (3,13). However, to date there have not been any published randomized trials that directly compared preemptive therapy and prophylaxis in nonrenal solid-organ transplant recipients and there are no available reports of studies that clearly indicate which strategy is superior (3,13).…”

Section: Discussionsupporting

confidence: 92%

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Monitoring of Cytomegalovirus (CMV)-Specific Cell-Mediated Immunity in Heart Transplant Recipients: Clinical Utility of the QuantiFERON-CMV Assay for Management of Posttransplant CMV Infection

et al. 2018

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Monitoring of Cytomegalovirus (CMV)-Specific Cell-Mediated Immunity in Heart Transplant Recipients: Clinical Utility of the QuantiFERON-CMV Assay for Management of Posttransplant CMV Infection

et al. 2018

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“…Others have suggested that CMV disease is associated with and increased risk of mortality in heart transplantation . Although valganciclovir has not been shown to be superior to oral ganciclovir for CMV disease prevention, its significantly higher bioavailability and reduced pill burden make it the drug of choice . It is possible that quantitative improvements in CMV prevention and management in the valganciclovir era may be contributing to the era effects on mortality we observed.…”

Section: Discussionmentioning

confidence: 92%

Impact of donor and recipient cytomegalovirus serology on long‐term survival of heart transplant recipients

Mabilangan

Preiksaitis

Cervera

2018

Transplant Infectious Dis

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Background: Some studies have shown that pre-transplant cytomegalovirus (CMV) serostatus is associated with heart transplant patient survival while others have not.We analyzed the relationship between pre-transplant donor/recipient CMV serostatus and long-term mortality in a retrospective cohort of heart transplant recipients at our center. Methods: Adult (Age >17 years) heart recipients transplanted between July 1985-December 2015 were analyzed. Variables included age, sex, pre-transplant donor (D)/recipient (R) serostatus [D−/R−, D−/R+, D+/R+, D+/R−], CMV infection within 2 years of transplant and transplant eras divided by changes in CMV prevention strategies: Era Survival analysis and Cox regression were performed at 10 years. Results: A total of 620 heart transplants were included in our analysis; 20% were CMV mismatched pre-transplant. Thirty-eight percent of patients were infected with CMV within the first two post-transplant years. Survival analysis showed D/R CMV serostatus did not significantly impact survival of heart recipients at 10 years (P = 0.11). Survival was significantly different across eras for D−/R+, D+/R+, and D+/ R+ (P = 0.043) but not D−/R− patients (P = 0.8). Cox regression revealed that patients transplanted in the valganciclovir era have an estimated 29% reduced risk of death (P = 0.047) compared to patients transplanted in the pre-ganciclovir era after controlling for age at transplantation, D/R CMV serostatus and CMV infection. Conclusion: Our review of the impact of CMV managed differently across eras suggests in heart transplantation there is no influence of D/R CMV serostatus on 10 year survival. K E Y W O R D S CMV prophylaxis, CMV serology, CMV serostatus, cytomegalovirus, heart transplantation, survival S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Mabilangan C, Preiksaitis JK, Cervera C; on behalf of the University of Alberta Cardiothoracic Transplant Group. Impact of donor and recipient cytomegalovirus serology on long-term survival of heart transplant recipients. Transpl Infect Dis. 2019;21:e13015.

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“…In this study we decided to focus our attention on viral pathogens, as they are more difficult to detect compared to the bacterial ones, and since the biological samples are more likely to be naive of antimicrobial treatment, reducing this risk of bias. According to the literature, the prevalence of virus isolations on BAL fluid in patients with CAP or HAP is about 17%, but it is estimated to be higher in case of transplanted patients [44,45]. One of the drawbacks of BAL is the risk to obtain an inadequate specimen, due to the variability of the sampling procedure [46].…”

Section: Discussionmentioning

confidence: 99%

Use of an innovative and non-invasive device for virologic sampling of cough aerosols in patients with community and hospital acquired pneumonia: a pilot study

et al. 2019

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Background: The aetiology of lower respiratory tract infections is challenging to investigate. Despite the wide array of diagnostic tools, invasive techniques, such as bronchoalveolar lavage (BAL), are often required to obtain adequate specimens. PneumoniaCheck TM is a new device that collects aerosol particles from cough, allowing microbiological analyses. Up to now it has been tested only for bacteria detection, but no study has investigated its usefulness for virus identification. Methods: In this pilot study we included 12 consecutive patients with pneumonia. After testing cough adequacy via a peak flow meter, a sampling with PneumoniaCheck TM was collected and a BAL was performed in each patient. Microbiological analyses for virus identification were performed on each sample and concordance between the two techniques was tested (sensitivity, specificity and positive/negative predictive values), taking BAL results as reference. Results: BAL was considered adequate in 10 patients. Among them, a viral pathogen was identified by PneumoniaCheck TM 6 times, each on different samples, whereas BAL allowed to detect the presence of a virus on 7 patients (14 positivities). Overall, the specificity for PneumoniaCheck TM to detect a virus was 100%, whereas the sensitivity was 66%. When considering only herpes viruses, PneumoniaCheck TM showed a lower sensitivity, detecting a virus in 1/4 of infected patients (25%). Conclusions: In this pilot study PneumoniaCheck TM showed a good correlation with BAL for non-herpes virologic identification in pneumonia patients, providing excellent specificity. Further studies on larger population are needed to confirm these results and define its place in the panorama of rapid diagnostic tests for lower respiratory tract infections.

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

Cited by 29 publications

References 113 publications

Monitoring of Cytomegalovirus (CMV)-Specific Cell-Mediated Immunity in Heart Transplant Recipients: Clinical Utility of the QuantiFERON-CMV Assay for Management of Posttransplant CMV Infection

Monitoring of Cytomegalovirus (CMV)-Specific Cell-Mediated Immunity in Heart Transplant Recipients: Clinical Utility of the QuantiFERON-CMV Assay for Management of Posttransplant CMV Infection

Impact of donor and recipient cytomegalovirus serology on long‐term survival of heart transplant recipients

Use of an innovative and non-invasive device for virologic sampling of cough aerosols in patients with community and hospital acquired pneumonia: a pilot study

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