title: Combined cytomegalovirus prophylaxis in lung transplantation: effects on acute rejection, lymphocytic bronchitis/bronchiolitis, and herpesvirus infections.
abstract: Lung transplantation recipients are at high risk for herpesvirus infections. We evaluated the effect of combined cytomegalovirus (CMV) prophylaxis on CMV pneumonia, acute rejection episodes (ARE), lymphocytic bronchitis/bronchiolitis (LB), and obliterans bronchiolitis (OB) diagnosed in 180 transbronchial biopsies (TBB) of lung transplant recipients. At our center, 25 patients (control group; 1999-2002) received acyclovir for 12 months and 21 recipients (study group; 2003-2007) received combined CMV prophylaxis consisting of CMV-IG (Cytotect Biotest) for 12 months and ganciclovir or valganciclovir from postoperative day 21 for 3 weeks. Among the study group (since 2005), CMV shell vial viral culture and Epstein-Barr virus (EBV), human herpesvirus-6 (HHV-6), and HHV-7 DNA were determined on BAL specimens. In the study group, the number of LB was significantly lower than in the control group (2% vs 11%; P= .04). Similar results were obtained for ARE (6% vs 17%; P= .04). No difference was observed in OB (5% vs 5%; P= .53, NS). A reduction trend was found in CMV pneumonia (2% vs 7%; P= .23, NS). Logistic regression analysis showed a relationship between prophylaxis and a reduced prevalence of ARE (odds ratio [OR] 3.25, confidence interval [CI] 1.12-9.40; P= .03). Finally, in the study group, BAL EBV-DNA positivity and EBV-CMV coinfections were low (6% and 0%, respectively) compared with other herpesviruses and with the literature. Our data suggested the efficacy of combined CMV prophylaxis to prevent ARE and LB, 2 risk factors for chronic rejection, and a possible role to reduce the trend toward CMV pneumonia and EBV infections.
authors.affiliation: Division of Pneumology, ASO S. Giovanni Battista di Torino and University of Torino, Turin, Italy. psolidoro@molinette.piemonte.it
authors.forename: P
authors.initials: P
authors.lastname: Solidoro
authors.forename: D
authors.initials: D
authors.lastname: Libertucci
authors.forename: L
authors.initials: L
authors.lastname: Delsedime
authors.forename: E
authors.initials: E
authors.lastname: Ruffini
authors.forename: M
authors.initials: M
authors.lastname: Bosco
authors.forename: C
authors.initials: C
authors.lastname: Costa
authors.forename: M
authors.initials: M
authors.lastname: Rinaldi
authors.forename: S
authors.initials: S
authors.lastname: Baldi
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use*; D001706:Biopsy; D001988:Bronchiolitis / Q000517:prevention & control*; D001991:Bronchitis / Q000517:prevention & control*; D003586:Cytomegalovirus Infections / Q000517:prevention & control*; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D006084:Graft Rejection / Q000453:epidemiology* / Q000517:prevention & control; D006566:Herpesviridae Infections / Q000517:prevention & control*; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects* / Q000473:pathology; D011183:Postoperative Complications / Q000517:prevention & control* / Q000821:virology; D012189:Retrospective Studies; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir; D000212:Acyclovir