title: Efficacy of a 6-week prophylactic ganciclovir regimen and the role of serial cytomegalovirus antibody testing in lung transplant recipients.
abstract: CMV is a frequently occurring pathogen in recipients of solid organ transplants, and those receiving lung transplants seem to be affected more frequently and more severely. Because the duration of prophylactic ganciclovir may influence the incidence of CMV disease in solid organ transplant recipients, we evaluated the efficacy of a 6-week prophylactic regimen in lung transplant recipients. We also evaluated the ability of a fourfold rise in CMV antibody titer to predict the development of CMV disease. Twenty-one consecutive lung transplant recipients were enrolled: 15 were CMV antibody-positive at the time of transplantation, and six were CMV antibody-negative and received a lung transplant from CMV-positive donors. Mean +/- SD follow-up was 430 +/- 157 days (range 178-730 days, median 449 days). The 6-week ganciclovir regimen prevented neither CMV infection (which occurred in 17/21 patients, 81%) nor CMV disease (seen in 8/21 patients, 38%). A fourfold rise in CMV antibody titer only preceded the onset of CMV disease in 3/13 instances (23%). We conclude that a 6-week regimen of ganciclovir prophylaxis does not prevent CMV infection or disease in lung transplant recipients and that a rise in serially obtained CMV antibody titers rarely precedes the development of CMV disease.
authors.affiliation: Department of Pharmacy, University of Washington Medical Center, Seattle 98195, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Kelly
authors.forename: R K
authors.initials: RK
authors.lastname: Albert
authors.forename: D E
authors.initials: DE
authors.lastname: Wood
authors.forename: G
authors.initials: G
authors.lastname: Raghu
mesh_terms: D000914:Antibodies, Viral / Q000097:blood*; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000517:prevention & control*; D005500:Follow-Up Studies; D015774:Ganciclovir / Q000627:therapeutic use*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D015994:Incidence; D016040:Lung Transplantation; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D000914:Antibodies, Viral; D015774:Ganciclovir