The Journal of Heart and Lung Transplantation
Volume 28, Issue 7 , Pages 670-675 , July 2009

Cytomegalovirus Prevention in High-risk Lung Transplant Recipients: Comparison of 3- vs 12-Month Valganciclovir Therapy

  • Peter Jaksch, MD

      Affiliations

    • Department of Cardio-thoracic Surgery, General Hospital Vienna, Vienna, Austria
    • Corresponding Author InformationReprint requests: Peter Jaksch, MD, Department of Thoracic Surgery, General Hospital Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. Telephone: 00-43-1-40400-7989. Fax: 00-43-1-40400-5642
    • ,
  • Barbara Zweytick, MD

      Affiliations

    • Department of Cardio-thoracic Surgery, General Hospital Vienna, Vienna, Austria
    • ,
  • Heidrun Kerschner, MD

      Affiliations

    • Institute of Clinical Virology, General Hospital Vienna, Vienna, Austria
    • ,
  • Ali Mir Hoda, MD

      Affiliations

    • Department of Cardio-thoracic Surgery, General Hospital Vienna, Vienna, Austria
    • ,
  • Maya Keplinger, MD

      Affiliations

    • Department of Cardio-thoracic Surgery, General Hospital Vienna, Vienna, Austria
    • ,
  • György Lang, MD

      Affiliations

    • Department of Cardio-thoracic Surgery, General Hospital Vienna, Vienna, Austria
    • ,
  • Clemens Aigner, MD

      Affiliations

    • Department of Cardio-thoracic Surgery, General Hospital Vienna, Vienna, Austria
    • ,
  • Walter Klepetko, MD

      Affiliations

    • Department of Cardio-thoracic Surgery, General Hospital Vienna, Vienna, Austria

Received 11 December 2008 ,Revised 24 February 2009 ,Accepted 5 March 2009.

References 

  1. Keller CA, Cagle PT, Brown RW, et al. Bronchiolitis obliterans in recipients of single, double, and heart–lung transplantation. Chest. 1995;107:973–980
  2. Keenan RJ, Lega ME, Dummer JS, et al. Cytomegalovirus serologic status and postoperative infection correlated with risk of developing chronic rejection after pulmonary transplantation. Transplantation. 1991;51:433–438
  3. Alexander BD, Tapson VF. Infectious complications of lung transplantation. Transplant Infect Dis. 2001;3:128–137
  4. Fishman JA, Emery V, Freeman R, et al. Cytomegalovirus in transplantation—challenging the status quo. Clin Transplant. 2007;21:149–158
  5. Zamora MR. Use of cytomegalovirus immune globulin and ganciclovir for the prevention of cytomegalovirus disease in lung transplantation. Transplant Infect Dis. 2001;3(suppl 2):49–56
  6. Duncan SR, Grgurich WF, Iacono AT, et al. A comparison of ganciclovir and acyclovir to prevent cytomegalovirus after lung transplantation. Am J Respir Crit Care Med. 1994;150:146–152
  7. Gerbase MW, Dubois D, Rothmeier C, et al. Costs and outcomes of prolonged cytomegalovirus prophylaxis to cover the enhanced immunosuppression phase following lung transplantation. Chest. 1999;116:1265–1272
  8. Gutierrez CA, Chaparro C, Krajden M, et al. Cytomegalovirus viremia in lung transplant recipients receiving ganciclovir and immune globulin. Chest. 1998;113:924–932
  9. Soghikian MV, Valentine VG, Berry GJ, et al. Impact of ganciclovir prophylaxis on heart–lung and lung transplant recipients. J Heart Lung Transplant. 1996;15:881–887
  10. Speich R, Thurnheer R, Gaspert A, et al. Efficacy and cost effectiveness of oral ganciclovir in the prevention of cytomegalovirus disease after lung transplantation. Transplantation. 1999;67:315–320
  11. Weill D, Lock BJ, Wewers DL, et al. Combination prophylaxis with ganciclovir and cytomegalovirus (CMV) immune globulin after lung transplantation: effective CMV prevention following daclizumab induction. Am J Transplant. 2003;3:492–496
  12. Wreghitt TG, Abel SJ, McNeil K, et al. Intravenous ganciclovir prophylaxis for cytomegalovirus in heart, heart–lung, and lung transplant recipients. Transplant Int. 1999;12:254–260
  13. Valentine VG, Weill D, Gupta MR, et al. Ganciclovir for cytomegalovirus: a call for indefinite prophylaxis in lung transplantation. J Heart Lung Transplant. 2008;27:875–881
  14. Pescovitz MD, Pruett TL, Gonwa T, et al. Oral ganciclovir dosing in transplant recipients and dialysis patients based on renal function. Transplantation. 1998;66:1104–1107
  15. Pescovitz MD, Rabkin J, Merion RM, et al. Valganciclovir results in improved oral absorption of ganciclovir in liver transplant recipients. Antimicrob Agents Chemother. 2000;44:2811–2815
  16. Zamora MR, Davis RD, Leonard C. Management of cytomegalovirus infection in lung transplant recipients: evidence-based recommendations. Transplantation. 2005;80:157–163
  17. Zamora MR, Nicolls MR, Hodges TN, et al. Following universal prophylaxis with intravenous ganciclovir and cytomegalovirus immune globulin, valganciclovir is safe and effective for prevention of CMV infection following lung transplantation. Am J Transplant. 2004;4:1635–1642
  18. Humar A, Paya C, Pescovitz MD, et al. Clinical utility of cytomegalovirus viral load testing for predicting CMV disease in D+/R− solid organ transplant recipients. Am J Transplant. 2004;4:644–649
  19. Humar A, Kumar D, Preiksaitis J, et al. A trial of valganciclovir prophylaxis for cytomegalovirus prevention in lung transplant recipients. Am J Transplant. 2005;5:1462–1468
  20. Ljungman P, Griffiths P, Paya C. Definitions of cytomegalovirus infection and disease in transplant recipients. Clin Infect Dis. 2002;34:1094–1097
  21. Husain AN, Siddiqui MT, Holmes EW, et al. Analysis of risk factors for the development of bronchiolitis obliterans syndrome. Am J Respir Crit Care Med. 1999;159:829–833
  22. Rubin RH. Importance of CMV in the transplant population. Transplant Infect Dis. 1999;1(suppl 1):3–7
  23. Danziger-Isakov LA, DelaMorena M, Hayashi RJ, et al. Cytomegalovirus viremia associated with death or retransplantation in pediatric lung-transplant recipients. Transplantation. 2003;75:1538–1543
  24. Zeevi A, Uknis ME, Spichty KJ, et al. Proliferation of cytomegalovirus-primed lymphocytes in bronchoalveolar lavages from lung transplant patients. Transplantation. 1992;54:635–639
  25. Pouteil-Noble C, Ecochard R, Landrivon G, et al. Cytomegalovirus infection—an etiological factor for rejection? (A prospective study in 242 renal transplant patients). Transplantation. 1993;55:851–857
  26. Lowance D, Neumayer HH, Legendre CM, et al. Valacyclovir for the prevention of cytomegalovirus disease after renal transplantation. N Engl J Med. 1999;340:1462–1470
  27. Flint A. Frank TS (Cytomegalovirus detection in lung transplant biopsy samples by polymerase chain reaction). J Heart Lung Transplant. 1994;13:38–42
  28. Arbustini E, Morbini P, Grasso M, et al. Human cytomegalovirus early infection, acute rejection, and major histocompatibility class II expression in transplanted lung (Molecular, immunocytochemical, and histopathologic investigations). Transplantation. 1996;61:418–427
  29. Cainelli F, Vento S. Infections and solid organ transplant rejection: a cause-and-effect relationship?. Lancet Infect Dis. 2002;2:539–549
  30. Duncan AJ, Dummer JS, Paradis IL, et al. Cytomegalovirus infection and survival in lung transplant recipients. J Heart Lung Transplant. 1991;10:638–644
  31. Smyth RL, Scott JP, Higenbottam TW, et al. Experience of cytomegalovirus infection in heart–lung transplant recipients. Transplant Proc. 1990;22:1820–1821
  32. Ettinger NA, Bailey TC, Trulock EP, et al. Cytomegalovirus infection and pneumonitis (Impact after isolated lung transplantation). Am Rev Respir Dis. 1993;147:1017–1023
  33. Tamm M, Aboyoun CL, Chhajed PN, et al. Treated cytomegalovirus pneumonia is not associated with bronchiolitis obliterans syndrome. Am J Respir Crit Care Med. 2004;170:1120–1123
  34. Luckraz H, Sharples L, McNeil K, et al. Cytomegalovirus antibody status of donor/recipient does not influence the incidence of bronchiolitis obliterans syndrome in lung transplantation. J Heart Lung Transplant. 2003;22:287–291
  35. Kroshus TJ, Kshettry VR, Savik K, et al. Risk factors for the development of bronchiolitis obliterans syndrome after lung transplantation. J Thorac Cardiovasc Surg. 1997;114:195–202
  36. Ruttmann E, Geltner C, Bucher B, et al. Combined CMV prophylaxis improves outcome and reduces the risk for bronchiolitis obliterans syndrome (BOS) after lung transplantation. Transplantation. 2006;81:1415–1420
  37. Kruger RM, Shannon WD, Arens MQ, et al. The impact of ganciclovir-resistant cytomegalovirus infection after lung transplantation. Transplantation. 1999;68:1272–1279
  38. Emery VC. Prophylaxis for CMV should not now replace pre-emptive therapy in solid organ transplantation. Rev Med Virol. 2001;11:83–86
  39. Singh N. Preemptive therapy versus universal prophylaxis with ganciclovir for cytomegalovirus in solid organ transplant recipients. Clin Infect Dis. 2001;32:742–751
  40. Hart GD, Paya CV. Prophylaxis for CMV should now replace pre-emptive therapy in solid organ transplantation. Rev Med Virol. 2001;11:73–81
  41. Limaye AP, Raghu G, Koelle DM, et al. High incidence of ganciclovir-resistant cytomegalovirus infection among lung transplant recipients receiving preemptive therapy. J Infect Dis. 2002;185:20–27
  42. Aigner C, Jaksch P, Winkler G, et al. Initial experience with oral valganciclovir for pre-emptive cytomegalovirus therapy after lung transplantation. Wien Klin Wochenschr. 2005;117:480–484

PII: S1053-2498(09)00159-4

doi: 10.1016/j.healun.2009.03.012

The Journal of Heart and Lung Transplantation
Volume 28, Issue 7 , Pages 670-675 , July 2009

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