Source: Annual Congress 2012 - Lung transplantation: studies in candidates and recipients
Disease area: Respiratory infections

Abstract

Among solid organ transplant recipients, lung transplant ones are at highest risk of cytomegalovirus (CMV) infection. The advent of CMV prophylaxis and changes in prophylactic protocols have contributed to a steady decline in CMV infection and mortality; however its potential impact on short-term outcome needs further investigation. The aim of the study is to evaluate the effect of combined CMV prophylaxis in reducing short term acute illness after transplant. A consecutive series of 52 CMV high-risk lung transplant recipients who had more than one year follow-up, were studied. The study group (n=26; age 44±2yrs) received ganciclovir or valganciclovir from postoperative day 15 and CMV-Immunoglobulins for six months, while the control group (n=26; 40±2yrs) was treated with pre-emptive therapy. Viral Infection Index (number of BAL with infection/total BAL number), acute rejection index (ARI, number of acute rejections/total transbronchial biopsies number), incidence of CMV pneumonia and early onset BOS were obtained. Viral Infection Index, infection index simply related to CMV as well as ARI were significantly reduced in the study group than in the control group (mean 33%Vs50% p=0.02; 14%Vs27% p=0.05 and 13%Vs26% p=0.04, respectively), while the incidence of CMV-pneumonia and BOS were similar in the two groups. A significant relationship between combined CMV prophylaxis and a reduced prevalence of acute rejection was observed by logistic regression analysis, even when considering grade A3 only (p=0.01). In conclusion our data underline the strong efficacy of combined CMV prophylaxis in reducing infections as well as acute rejections, particularly the most severe ones, in lung transplant recipients.

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E. Balestro, E. Rossi, F. Lunardi, M. Damin, N. Nannini, M. Loy, G. Marulli, F. Rea, F. Calabrese (Padova, Italy). Combined CMV prophylaxis reduces short term complications after lung transplantation. Eur Respir J 2012; 40: Suppl. 56, 1488

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