The risk, prevention, and outcome of cytomegalovirus after pediatric lung transplantation.
BACKGROUND
A retrospective review of pediatric lung transplant recipients at 14 centers in North America and Europe was conducted to characterize the epidemiology and the risk factors for cytomegalovirus (CMV) and to explore the impact of preventative antiviral therapy.


METHODS
Data were recorded for 1 year posttransplant. Associations between CMV and continuous and categorical risk factors were assessed using Wilcoxon rank sum and chi-square tests, respectively. Associations between time to CMV and risk factors or survival were assessed by multivariable Cox proportional hazards models.


RESULTS
Within 12 months posttransplant, 172 of 577 subjects (29.8%) developed 218 CMV episodes (90 asymptomatic infection, 25 syndrome, and 103 disease). Forty-one subjects developed more than one episode of CMV. Donor or recipient CMV seropositivity was associated with increased risk of CMV episodes. Except for decreased prophylaxis in CMV D-/R- subjects, duration of prophylaxis did not vary by D/R serostatus. For CMV D+ subjects, not being on prophylaxis at the time of CMV episode increased the risk of CMV (D+/R+ hazard ratio 3.5, 95% confidence interval 1.4-8.4; D+/R- 1.9, 1.02-3.7). CMV was associated with increased mortality within the first posttransplant year among those with donor or recipient CMV seropositivity (hazard ratio 2.0: 95% confidence interval 1.1-3.6; P=0.024).


CONCLUSIONS
CMV remains a serious complication after pediatric lung transplant, and the impact of prophylaxis is complex.
Danziger-Isakov
Lara A
LA
Pediatric Infectious Diseases, The Children's Hospital at Cleveland Clinic, Cleveland, OH 44195, USA. DANZIGL@ccf.org
Worley
Sarah
S
Michaels
Marian G
MG
Arrigain
Susana
S
Aurora
Paul
P
Ballmann
Manfred
M
Boyer
Debra
D
Conrad
Carol
C
Eichler
Irmgard
I
Elidemir
Okan
O
Goldfarb
Samuel
S
Mallory
George B
GB
Mogayzel
Peter J
PJ
Parakininkas
Daiva
D
Solomon
Melinda
M
Visner
Gary
G
Sweet
Stuart
S
Faro
Albert
A
D000208:Acute Disease; D001989:Bronchiolitis Obliterans / Q000453:epidemiology / Q000473:pathology; D002648:Child; D016572:Cyclosporine / Q000627:therapeutic use; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control*; D005060:Europe; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000821:virology; D016041:Heart-Lung Transplantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D016040:Lung Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D015999:Multivariate Analysis; D009656:North America; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors; D016559:Tacrolimus / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus