Is gammaglobulin anti-CMV warranted in lung transplantation?
The usefulness of anti-CMV hyperimmune gammaglobulin (IgG-CMV, Cytotec) in lung transplant patients (LTx) is controversial. The objective of this study was to analyze the effectiveness of IgG-CMV in our LTx receptors.


METHODS
A retrospective study of LTx recipients treated with IgG-CMV as prophylaxis or as treatment for invasive disease. We used IgG-CMV associated with IV ganciclovir (GCV) as treatment for invasive disease. High-risk patients (CMV-negative recipients from CMV-positive donors; CMV-/+) were also with IgG-CMV prophylaxis during the first year. Other prophylactic uses of IgG-CMV were as an alternative to GCV in patients with related GCV toxicity, and as preemptive therapy in cases of persistent positive viral load (antigenemia > or = 1 cell and/or a PCR > or = 400) although oral GCV administration.


RESULTS
Between January 2000 and August 2003, 14 of the 74 lung transplant recipients (19%) received IgG-CMV as treatment for invasive disease (4 cases: 2 gastritis, 1 esophagitis, 1 hepatitis) and/or as prophylaxis (14 cases). All patients treated for invasive disease evolved favorably. No therapeutic failure were observed in CMV-/+ patients during treatment. Three of the six patients treated with IgG-CMV developed positive antigenemia despite treatment. The four patients treated for persistent antigenemia while receiving oral GCV achieved neutralization during the first month of treatment.


CONCLUSIONS
IgG-CMV associated with Gancyclovir is effective as treatment for invasive disease and as pre-emptive therapy in patients with persistent positive viral load. In CMV-/+ recipients, IgG-CMV prevents pneumonitis and delays the development of invasive disease after the first year.
García-Gallo
C López
CL
Lung Trasplant Unit, Clinica Puerta de Hierro, Madrid, Spain. crisneumo@terra.es
Gil
P Ussetti
PU
Laporta
R
R
Carreño
M C
MC
de Pablo
A
A
Ferreiro
M J
MJ
D000293:Adolescent; D000328:Adult; D003587:Cytomegalovirus / Q000276:immunology* / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D006801:Humans; D007116:Immunization, Passive; D007074:Immunoglobulin G / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016040:Lung Transplantation / Q000276:immunology; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control* / Q000821:virology*; D012189:Retrospective Studies; D019562:Viral Load; D005719:gamma-Globulins / Q000627:therapeutic use*
D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D005719:gamma-Globulins