title: Long-term outcomes of cytomegalovirus infection and disease after lung or heart-lung transplantation with a delayed ganciclovir regimen.
abstract: BACKGROUND
  Information is limited on long-term outcomes after preemptive use of ganciclovir to control cytomegalovirus (CMV) infection in lung transplantation.
  
  
  METHODS
  We studied 78 lung recipients who received antithymocyte globulin induction from 1994 to 2000. All patients received six months of oral acyclovir (800 mg TID). This was interrupted three wk post transplantation for a two-wk course of IV ganciclovir. Additional courses of ganciclovir were administered based on serial virological monitoring. CMV-mismatched patients (R-D+) also received four doses of CMV immunoglobulin between weeks 2 and 8.
  
  
  RESULTS
  The one yr cumulative risk of CMV disease was 2% (1/61) in CMV seropositive (R+) patients, but was 37% (6/17) in R-D+ patients (p < 0.0001). Over 4.3 yr of follow-up, patients with CMV infection developed more chronic graft dysfunction caused by bronchiolitis obliterans or bronchiolitis obliterans syndrome than patients without CMV infection (p = 0.012). This effect was also apparent in the subgroup of R+ recipients (p = 0.043). Acute rejection and overall survival were not associated with CMV infection.
  
  
  CONCLUSIONS
  The use of prophylactic acyclovir and short preemptive courses of ganciclovir effectively controlled CMV disease in R+ patients, but was a relative failure in R-D+ patients. CMV infection was significantly associated with chronic graft dysfunction, even in R+ recipients who had good control of CMV symptoms.
authors.affiliation: Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
authors.forename: Lora D
authors.initials: LD
authors.lastname: Thomas
authors.forename: Aaron P
authors.initials: AP
authors.lastname: Milstone
authors.forename: Geraldine G
authors.initials: GG
authors.lastname: Miller
authors.forename: James E
authors.initials: JE
authors.lastname: Loyd
authors.forename: J
authors.initials: J
authors.lastname: Stephen Dummer
mesh_terms: D000212:Acyclovir / Q000008:administration & dosage; D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage*; D018890:Chemoprevention; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000517:prevention & control* / Q000635:transmission; D051799:Delayed Graft Function / Q000821:virology; D004334:Drug Administration Schedule; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage*; D016041:Heart-Lung Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir; D000212:Acyclovir