Late‐Onset Cytomegalovirus (CMV) in Lung Transplant Recipients: Can CMV Serostatus Guide the Duration of Prophylaxis?

• Published in: American journal of transplantation Vol. 13; no. 2; pp. 376 - 382
• Main Authors: Schoeppler, K. E., Lyu, D. M., Grazia, T. J., Crossno, J. T., Vandervest, K. M., Zamora, M. R.
• Format: Journal Article
• Language: English
• Published: Hoboken, NJ Wiley 01.02.2013; Elsevier Limited
• Subjects: Acute rejection; Adult; Aged; Antibodies, Viral - blood; Antiviral Agents - therapeutic use; Biological and medical sciences; Confidence intervals; Cytomegalovirus; cytomegalovirus (CMV); Cytomegalovirus - isolation & purification; Cytomegalovirus Infections - blood; Cytomegalovirus Infections - complications; Cytomegalovirus Infections - prevention & control; Female; Ganciclovir - analogs & derivatives; Ganciclovir - therapeutic use; Graft Rejection; Herpesviridae; Humans; Immunosuppressive Agents - therapeutic use; Infectious diseases; Lung Diseases - complications; Lung Diseases - therapy; Lung Diseases - virology; lung transplant; Lung Transplantation - methods; Male; Medical sciences; Middle Aged; Multivariate Analysis; Odds Ratio; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; serostatus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue Donors; Transplants & implants; Treatment Outcome; Valganciclovir; Viral diseases; Graft(material); Acyclic nucleoside; Purine nucleoside; Guide; lung transplant; Lung; Transplantation; Homotransplantation; Respiratory system; Betaherpesvirinae; Human cytomegalovirus; Prevention; Age of onset; Surgery; Nucleoside analog; Graft; Antiviral; DNA polymerase inhibitor; Opportunistic infection; Acute rejection; Late; Valganciclovir; serostatus; Herpesviridae; Acute; Duration; Prodrug; Infection; Virus; Rejection; Treatment; Viral disease; cytomegalovirus (CMV)
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2012.04339.x

Evidence supports the use of 12 months of cytomegalovirus prophylaxis in all at‐risk lung transplants; whether cytomegalovirus serostatus can be used to further optimize this duration remains to be determined. The purpose of this retrospective study was to determine if cytomegalovirus serostatus of both donor and recipient were associated with late‐onset cytomegalovirus. The primary outcome was the proportion of lung transplants that developed cytomegalovirus infection or disease during the 180‐day period following 6 months of prophylaxis in each at‐risk serotype. Two hundred forty‐four consecutive lung transplants were evaluated, 131 were included. The proportion of recipients with cytomegalovirus differed significantly between serotypes (20 of 41 [48.8%] D+/R‐ vs. 19 of 56 [33.9%] D+/R+ vs. 2 of 34 [5.9%] D‐/R+; p < 0.001). In a multivariate model, older age (odds ratio [OR], 1.05, 95% confidence interval [CI] 1.004–1.099; p = 0.03) and D+/R‐ serostatus (OR, 3.83; 95% CI 1.674–8.770; p = 0.002) were associated with cytomegalovirus. Among R+ lung transplants, D‐ serostatus was associated with the absence of cytomegalovirus (OR, 0.12; 95% CI 0.0263–0.563; p = 0.007). These findings suggest that in the valganciclovir era, cytomegalovirus serostatus of both donor and recipient may identify lung transplants at heightened risk for late‐onset cytomegalovirus. This retrospective study evaluates the proportion of lung transplant recipients who developed cytomegalovirus infection or disease following completion of 6 months of cytomegalovirus prophylaxis and demonstrates a significant difference between the three at‐risk cytomegalovirus serostatuses.