Early diagnosis and effective treatment of pulmonary CMV infection after lung transplantation.
The early diagnosis and effective treatment of cytomegalovirus (CMV) pneumonia remains a keystone for patient survival after lung transplantation. At present, the use of DHPG (ganciclovir sodium) opens the possibility of a potent antiviral therapy. The use of monoclonal antibodies directed to immediate early CMV antigens offers a fast method to detect the early phase of systemic or local viral replication. Five single lung and heart-lung transplant patients at high risk for CMV infection (donor, CMV-positive; recipient, CMV-negative) were monitored by cellular immunohistology for immediate early antigens. Specimens from bronchoalveolar lavage (n = 39) and bronchial biopsies (n = 17), and peripheral blood leukocytes (n = 57) were examined. In peripheral blood leukocytes and bronchial biopsy specimens no CMV-positive cells were detected. The bronchoalveolar lavage analysis of two patients showed immediate early antigen-positive cells after 1 to 3 months. At the same time the patients had clinical symptoms that could also be related to lung rejection. Serologic conversion (CMV-IgM) occurred only 6 days later in one patient with informative follow-up analysis; CMV culture (available 4 to 6 weeks later) confirmed the diagnosis retrospectively. DHPG treatment was started immediately and resulted in CMV antigen negativity in bronchoalveolar lavage fluid after one or two courses (10 mg/kg/day; 14 days). Direct antigen detection offers a fast and specific monitoring of early CMV infection. The implications to the clinical management of lung transplant patients are discussed.
Steinhoff
G
G
Center of Surgery and Internal Medicine, Medical School Hannover, F.R.G.
Behrend
M
M
Wagner
T O
TO
Höper
M H
MH
Haverich
A
A
D000328:Adult; D000911:Antibodies, Monoclonal; D000956:Antigens, Viral / Q000032:analysis; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology; D003587:Cytomegalovirus / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use*; D016041:Heart-Lung Transplantation; D006801:Humans; D007116:Immunization, Passive; D016040:Lung Transplantation; D008297:Male; D011024:Pneumonia, Viral / Q000175:diagnosis* / Q000628:therapy*
D000911:Antibodies, Monoclonal; D000956:Antigens, Viral; D015774:Ganciclovir