Cytomegalovirus Infection and Disease in Lung Transplant Recipients

Abstract

Purpose Cytomegalovirus (CMV) infection causes significant morbidity and mortality in lung transplant recipients (LTR), the most important risk factor for which is the serostatus of donor (D) and recipient (R). Our program employs a CMV prophylaxis strategy. In 2016, our protocol for management of D+ R- changed from 3-6 months of valganciclovir (VGCV) with CMV hyperimmune globulin to 12 months of VGCV with human normal immunoglobulin. Aims: To determine the effect of changing CMV prophylaxis protocol for D+ R- on the incidence of CMV infection/disease in LTR. Methods We retrospectively reviewed laboratory results and clinical notes from all LTR transplanted between 1/01/2014 - 31/12/2017 in the National Heart and Lung Transplant Centre, Ireland. Data were collected for a minimum of ten months post-transplant, with a longer follow-up of those transplanted earlier. Results Data were available on 134 of 137 LTR, Table 1. There were fewer episodes of infection (14 v 30, p = 0.19) and less tissue invasive disease (TID) (0 v 4, p = 0.14) in the D+ R- 2016-17 group. The average time to infection/disease was longer (9 v 7.7 months) in the 2016-17 group. The incidence of CMV infection and disease was 29% in LTR transplanted in 2016-17 and 36% in 2014-15. Conclusion Recent guidelines (1) advocate a minimum of 6 months VGCV prophylaxis in D+ R- LTR. Our data demonstrates there is a trend for less adverse events such as TID with a longer duration. The average time to infection in the 2016-17 group of 9 months suggests some patients are not tolerating prophylaxis and terminating early. In conclusion, following a change in protocol less CMV infection episodes and no invasive CMV disease were reported in our cohort. Reduction in CMV disease and infection will reduce graft loss, morbidity and mortality. Innovations to improve tolerability of VGCV may further delay time to infection.