title: Cytomegalovirus and long-term outcome after lung transplantation in Gothenburg, Sweden.
abstract: Prophylaxis with ganciclovir has decreased the initially high morbidity related to cytomegalovirus (CMV) after lung transplantation, but the optimal length of prophylaxis and the long-term outcome have not yet been established. The impact of CMV on the short- and long-term outcome was studied in 187 lung transplant recipients in Gothenburg, Sweden, 1990-2002. Among CMV-seronegative patients receiving grafts from seropositive donors (D+/R-), 88% developed CMV disease, 40% if both donor and recipient were CMV-seropositive (D+/R+) and 26% if only the recipient was CMV-seropositive (D-/R+). Among CMV-seropositive recipients (R+) on oral acyclovir prophylaxis, 38% developed CMV disease, as compared with 39% on intravenous ganciclovir for 4 weeks and 28% on oral ganciclovir for 14 weeks. On average, CMV disease appeared at 41 days in the R+ on acyclovir prophylaxis, at 75 days on 4 weeks of i.v. ganciclovir and at 162 days on 14 weeks of oral ganciclovir. CMV disease was associated with a statistically significant increased risk of developing chronic rejection (bronchiolitis obliterans syndrome) at both 1 and 2 y after transplantation. CMV disease also had a significant negative impact on survival, with a 10-y survival of only 32% as compared with 53% after asymptomatic CMV infection and 57% with no CMV.
authors.affiliation: Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden. inger.johansson@infect.gu.se
authors.forename: Inger
authors.initials: I
authors.lastname: Johanssson
authors.forename: Gunnar
authors.initials: G
authors.lastname: Mårtensson
authors.forename: Rune
authors.initials: R
authors.lastname: Andersson
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D018890:Chemoprevention / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use*; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir; D000212:Acyclovir