Cytomegalovirus immunoglobulin decreases the risk of cytomegalovirus infection but not disease after pediatric lung transplantation.
BACKGROUND
Cytomegalovirus (CMV) has been associated with morbidity, including chronic allograft rejection, in transplant recipients. Data from adult centers suggests that CMV hyperimmune globulin (CMVIG) and ganciclovir together are superior in preventing CMV viremia than ganciclovir alone.


METHODS
A retrospective review of pediatric lung transplant recipients at 14 sites in North America and Europe was conducted to evaluate the effect of adding cytomegalovirus immunoglobulin (CMVIG) prophylaxis to at least 3 weeks of intravenous ganciclovir therapy in pediatric lung transplant recipients. Data were recorded for the first year after transplantation. Associations between time to CMV and risk factors, including CMVIG use, were assessed by multivariable Cox proportional hazards models.


RESULTS
Of 599 patients whose records were reviewed, 329 received at least 3 weeks of ganciclovir, with 62 (19%) receiving CMVIG. CMVIG was administered more frequently with CMV donor-positive/recipient-negative serostatus (p < 0.05). In multivariable models, patients who did not receive CMVIG as part of their prophylaxis were 3 times more likely to develop CMV infection (hazard ratio, 3.4; 95% confidence interval, 1.2-9.5) independent of CMV serostatus. However, CMVIG administration was not associated with decreased risk of episodes of CMV disease. Receipt of CMVIG was not associated with decreased risks of post-transplant morbidities (acute rejection, respiratory viral infection or early bronchiolitis obliterans) or morbidity within the first year after pediatric lung transplantation.


CONCLUSIONS
The use of CMVIG in addition to antiviral prophylaxis in pediatric lung transplantation requires further evaluation.
Northwestern University School of Medicine, Chicago, Illinois, USA.
Kavitha
K
Ranganathan
Sarah
S
Worley
Marian G
MG
Michaels
Susana
S
Arrigan
Paul
P
Aurora
Manfred
M
Ballmann
Debra
D
Boyer
Carol
C
Conrad
Irmgard
I
Eichler
Okan
O
Elidemir
Samuel
S
Goldfarb
George B
GB
Mallory
Peter J
PJ
Mogayzel
Daiva
D
Parakininkas
Melinda
M
Solomon
Gary
G
Visner
Stuart C
SC
Sweet
Albert
A
Faro
Lara
L
Danziger-Isakov
D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use; D001989:Bronchiolitis Obliterans / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use*; D016756:Immunoglobulins, Intravenous; D015994:Incidence; D007223:Infant; D016040:Lung Transplantation; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D014766:Viremia / Q000453:epidemiology / Q000517:prevention & control*; D055815:Young Adult
D000998:Antiviral Agents; D007136:Immunoglobulins; D016756:Immunoglobulins, Intravenous; C045781:cytomegalovirus-specific hyperimmune globulin; D015774:Ganciclovir