title: Combined CMV prophylaxis improves outcome and reduces the risk for bronchiolitis obliterans syndrome (BOS) after lung transplantation.
abstract: BACKGROUND
  The benefit of cytomegalovirus (CMV) hyperimmune globuline in preventing CMV infection after lung transplantation still remains unclear. The aim of this study was to investigate the effect of combined prophylaxis using ganciclovir (GAN) and CMV hyperimmune globulin (CMV-IG) on CMV infection, CMV disease, survival and its role in preventing Bronchiolitis obliterans syndrome (BOS).
  
  
  METHODS
  A consecutive series of 68 CMV high-risk lung transplant recipients (D+/R-, D+/R+), who had a minimum follow-up of 1 year posttransplant were analyzed. Thirty patients (44.1%) received single GAN prophylaxis for 3 months (control group) and 38 recipients (55.9%) received GAN together with CMV-IG 7 times during the first postoperative month (study group). Median follow-up was 16.5 months in the control and 23.8 months in the study group (P = 0.54).
  
  
  RESULTS
  Five CMV-related deaths (16.7%) occurred in the control group (P = 0.014). Fifteen recipients suffered from CMV pneumonitis and three patients had CMV syndrome. In the control group, 13 recipients (43.3%) suffered from clinically manifested CMV disease compared to 5 (13.2%) in the study group (P = 0.007). Additionally, recipient survival was significantly better in the study group (P = 0.01). One year freedom from CMV affection was 52.1% in the control and 71.5% in the study group (P = 0.027). Three-year freedom from BOS was significantly higher in the study group (54.3% vs. 82%, P = 0.024).
  
  
  CONCLUSIONS
  In CMV high risk patients, additional CMV-IG administration seems to be effective to reduce CMV-related morbidity and to avoid CMV-related mortality. Reduced incidence of BOS may result from improved CMV prevention, although randomized trials are warranted.
authors.affiliation: Department of Cardiac Surgery, Medical University Innsbruck, Austria. elfriede.ruttmann@uibk.ac.at
authors.forename: Elfriede
authors.initials: E
authors.lastname: Ruttmann
authors.forename: Christian
authors.initials: C
authors.lastname: Geltner
authors.forename: Brigitte
authors.initials: B
authors.lastname: Bucher
authors.forename: Hanno
authors.initials: H
authors.lastname: Ulmer
authors.forename: Daniel
authors.initials: D
authors.lastname: Höfer
authors.forename: Herbert B
authors.initials: HB
authors.lastname: Hangler
authors.forename: Severin
authors.initials: S
authors.lastname: Semsroth
authors.forename: Raimund
authors.initials: R
authors.lastname: Margreiter
authors.forename: Günther
authors.initials: G
authors.lastname: Laufer
authors.forename: Ludwig C
authors.initials: LC
authors.lastname: Müller
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D001989:Bronchiolitis Obliterans / Q000517:prevention & control*; D003586:Cytomegalovirus Infections / Q000276:immunology / Q000517:prevention & control*; D004359:Drug Therapy, Combination; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use*; D006801:Humans; D007116:Immunization, Passive; D007136:Immunoglobulins / Q000627:therapeutic use*; D016756:Immunoglobulins, Intravenous; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000998:Antiviral Agents; D007136:Immunoglobulins; D016756:Immunoglobulins, Intravenous; C045781:cytomegalovirus-specific hyperimmune globulin; D015774:Ganciclovir