title: Cytomegalovirus infection in lung transplant patients: the role of prophylaxis and recipient-donor serotype matching.
abstract: Cytomegalovirus (CMV) remains an important cause of morbidity and mortality in lung transplant recipients. We investigated the incidence of CMV infection in relation to CMV prophylaxis, and recipient-donor CMV serotype, in a cohort of 250 consecutive lung transplant recipients. All patients received 3 months CMV prophylaxis with acyclovir (n = 67) or gancyclovir (n = 183). Recipient-donor CMV serotype matching was performed in patients receiving acyclovir: R+/D+(n = 38), R+/D-(n = 10), R-/D+(n = 1), R- /D-(n = 16), unknown (n = 2). Recipient-donor CMV serotype matching was not performed in patients receiving gancyclovir: R+/D+(n = 71), R+/D-(n = 42), R-/D+(n = 38), R-/D-(n = 31), unknown (n = 1). The overall incidence of CMV infection was 51% (n = 34) in the acyclovir group, and 42% (n = 77) in the gancyclovir group (p = 0.14). During the first 9 months after transplantation, the rate of CMV infection was higher in the acyclovir group (42%) compared with the gancyclovir group (30%) (p = 0.005). Multivariate analysis demonstrated the incidence of CMV infection during the first 9 months was higher for acyclovir prophylaxis (p<0.001) and R-/D+ serostatus (p<0.001) and lower with R-/D- serostatus (p = 0.02). In conclusion, gancyclovir significantly delays the onset of first CMV infection among lung transplant patients. CMV surveillance and choice of prophylaxis may be modified according to donor-recipient CMV serotype.
authors.affiliation: Division of Lung Transplantation, Department of Medicine B, Rigshospitalet, Copenhagen, Denmark. cmburton@doctors.net.uk
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Burton
authors.forename: Pernille
authors.initials: P
authors.lastname: Kristensen
authors.forename: Rikke
authors.initials: R
authors.lastname: Lützhøft
authors.forename: Mette
authors.initials: M
authors.lastname: Rasmussen
authors.forename: Nils
authors.initials: N
authors.lastname: Milman
authors.forename: Jørn
authors.initials: J
authors.lastname: Carlsen
authors.forename: Claus Bohn
authors.initials: CB
authors.lastname: Christiansen
authors.forename: Claus B
authors.initials: CB
authors.lastname: Andersen
authors.forename: Martin
authors.initials: M
authors.lastname: Iversen
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use*; D000293:Adolescent; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D001788:Blood Grouping and Crossmatching; D002648:Child; D003586:Cytomegalovirus Infections / Q000517:prevention & control*; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use*; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir; D000212:Acyclovir