Abstract
BackgroundCytomegalovirus (CMV) is the most common opportunistic infection following lung transplantation. CMV replication in the lung allograft is described as accelerating the development of bronchiolitis obliterans syndrome (BOS). Finding a strategy to prevent CMV infection is an important issue.MethodsWe performed a retrospective, single-centre study of 114 lung transplant recipients (LTRs) who underwent lung transplantation from January 2001 to December 2006. In a smaller cohort of 88 CMV seropositive (R+) LTRs, three months of valganciclovir prophylaxis (2004-2006) was compared to three months of oral ganciclovir (2001-2003) with respect to the incidence of CMV infection/disease, the severity of CMV disease, acute rejection, BOS-free 4 year survival and 4 year survival. In the whole group of 114 LTRs the impact of CMV infection on long-term survival (BOS free 4 year survival and 6 year survival) was assessed.ResultsFor the cohort of 88 CMV seropositive LTRs, the incidence of CMV infection/disease at one year was lower in the valganciclovir group compared to the ganciclovir group (24% vs. 54%, p = 0.003). There was a tendency towards reduced CMV disease, from 33% to 20% and a significant lower incidence of asymptomatic CMV infection (22% vs. 4%, p = 0.005). A lower incidence of acute rejection was observed in the valganciclovir group. However, there was no significant difference between the two groups in BOS free 4 year survival and 4 year survival.For the entire group of 114 LTRs, BOS-free 4 year survival for recipients with CMV disease was (32%, p = 0.005) and among those with asymptomatic CMV infection (36%, p = 0.061) as compared with patients without CMV infection (69%). Six year survival was lower among patients with CMV disease, (64%, p = 0.042) and asymptomatic CMV infection (55%, p = 0.018) than patients without CMV infection (84%).ConclusionsA lower incidence of CMV infection/disease and acute rejections was observed with valganciclovir (3 months) when compared to oral ganciclovir (3 months). The long-term impact of CMV infection/disease was significant for BOS-free survival and survival.
Highlights
Cytomegalovirus (CMV) is the most common opportunistic infection following lung transplantation
In a previous study of 187 lung transplant recipients (LTRs) we reported that oral ganciclovir (GCV) prophylaxis for 3 months delayed the onset and reduced the severity of CMV disease when compared to intravenous (IV) ganciclovir for 4 weeks [4]
Survival in the total group (R + and R-) Six year survival was lower among patients with CMV disease, (64%, p = 0.042) and asymptomatic CMV infection (55%, p = 0.018) as compared with patients without CMV infection (84%)
Summary
Cytomegalovirus (CMV) is the most common opportunistic infection following lung transplantation. Finding a strategy to prevent CMV infection is an important issue. Cytomegalovirus (CMV) is the most clinically significant opportunistic infection that can occur following lung transplantation (LTx). The reported incidence of CMV infection/disease ranges from 38% to 75% in lung transplant recipients (LTRs) in the absence of any prophylaxis [1]. Finding strategies to prevent CMV infection/disease is a major challenge following lung transplantation. In a previous study of 187 LTRs we reported that oral ganciclovir (GCV) prophylaxis for 3 months delayed the onset and reduced the severity of CMV disease when compared to intravenous (IV) ganciclovir for 4 weeks [4]. IV GCV followed by VGCV or VGCV alone are the most common prophylaxis strategies [5]. Valganciclovir is a prodrug of ganciclovir with greater bioavailability (60%) than oral GCV (6%) and oral GCV 1000 mg t.i.d.is equivalent to VGCV 450 mg daily [6]
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