Effect of Cytomegalovirus Immunoglobulin on the Incidence of Lymphoproliferative Disease After Lung Transplantation

Abstract

Posttransplantation lymphoproliferative disorder (PTLD), a complication of lung transplantation with an incidence ranging from as much as 20%, is mainly associated with Epstein-Barr virus (EBV) infection. In renal transplantation, the use of immunoglobulin (Ig) cytomegalovirus (CMV) prophylaxis, which contains anti-EBV antibodies, resulted in a significant lower incidence of PTLD. In this study, we report our experience with PTLD in lung transplantation with CMV Ig prophylaxis. One-thousand one-hundred fifty-seven consecutive patients who underwent lung transplantation at the Medical University of Vienna between November 1989 and December 2011 were included in this retrospective analysis on PTLD. CMV prophylaxis consisted in all patients of antiviral drugs (ganciclovir/valganciclovir) combined with anti-CMV Ig for 4 weeks. A total of 18 patients (1.5%) developed PTLD of B cell origin. Fifteen patients were diagnosed in the first posttransplantation year, and three patients, beyond 1 year. One- and three-year survival after diagnosis of PTLD was 50% and 38%, respectively. The incidence of PTLD in our center is extremely low when compared with the scientific literature. We hypothesize that CMV Ig prophylaxis also protects from EBV-associated PTLD.