title: The risk, prevention, and outcome of cytomegalovirus after pediatric lung transplantation.
abstract: 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.
authors.affiliation: Pediatric Infectious Diseases, The Children's Hospital at Cleveland Clinic, Cleveland, OH 44195, USA. DANZIGL@ccf.org
authors.forename: Lara A
authors.initials: LA
authors.lastname: Danziger-Isakov
authors.forename: Sarah
authors.initials: S
authors.lastname: Worley
authors.forename: Marian G
authors.initials: MG
authors.lastname: Michaels
authors.forename: Susana
authors.initials: S
authors.lastname: Arrigain
authors.forename: Paul
authors.initials: P
authors.lastname: Aurora
authors.forename: Manfred
authors.initials: M
authors.lastname: Ballmann
authors.forename: Debra
authors.initials: D
authors.lastname: Boyer
authors.forename: Carol
authors.initials: C
authors.lastname: Conrad
authors.forename: Irmgard
authors.initials: I
authors.lastname: Eichler
authors.forename: Okan
authors.initials: O
authors.lastname: Elidemir
authors.forename: Samuel
authors.initials: S
authors.lastname: Goldfarb
authors.forename: George B
authors.initials: GB
authors.lastname: Mallory
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Mogayzel
authors.forename: Daiva
authors.initials: D
authors.lastname: Parakininkas
authors.forename: Melinda
authors.initials: M
authors.lastname: Solomon
authors.forename: Gary
authors.initials: G
authors.lastname: Visner
authors.forename: Stuart
authors.initials: S
authors.lastname: Sweet
authors.forename: Albert
authors.initials: A
authors.lastname: Faro
mesh_terms: 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
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus