title: Lower incidence of CMV infection and acute rejections with valganciclovir prophylaxis in lung transplant recipients.
abstract: BACKGROUND
  Cytomegalovirus (CMV) is the most common opportunistic infection following lung transplantation. CMV replication in the lung allograft is described as accelerating the development of bronchiolitis obliterans syndrome (BOS). Finding a strategy to prevent CMV infection is an important issue.
  
  
  METHODS
  We performed a retrospective, single-centre study of 114 lung transplant recipients (LTRs) who underwent lung transplantation from January 2001 to December 2006. In a smaller cohort of 88 CMV seropositive (R+) LTRs, three months of valganciclovir prophylaxis (2004-2006) was compared to three months of oral ganciclovir (2001-2003) with respect to the incidence of CMV infection/disease, the severity of CMV disease, acute rejection, BOS-free 4 year survival and 4 year survival. In the whole group of 114 LTRs the impact of CMV infection on long-term survival (BOS free 4 year survival and 6 year survival) was assessed.
  
  
  RESULTS
  For the cohort of 88 CMV seropositive LTRs, the incidence of CMV infection/disease at one year was lower in the valganciclovir group compared to the ganciclovir group (24% vs. 54%, p = 0.003). There was a tendency towards reduced CMV disease, from 33% to 20% and a significant lower incidence of asymptomatic CMV infection (22% vs. 4%, p = 0.005). A lower incidence of acute rejection was observed in the valganciclovir group. However, there was no significant difference between the two groups in BOS free 4 year survival and 4 year survival.For the entire group of 114 LTRs, BOS-free 4 year survival for recipients with CMV disease was (32%, p = 0.005) and among those with asymptomatic CMV infection (36%, p = 0.061) as compared with patients without CMV infection (69%). Six year survival was lower among patients with CMV disease, (64%, p = 0.042) and asymptomatic CMV infection (55%, p = 0.018) than patients without CMV infection (84%).
  
  
  CONCLUSIONS
  A lower incidence of CMV infection/disease and acute rejections was observed with valganciclovir (3 months) when compared to oral ganciclovir (3 months). The long-term impact of CMV infection/disease was significant for BOS-free survival and survival.
authors: Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. inger.johansson@infect.gu.se.
authors: Inger
authors: I
authors: Johansson
authors: Gunnar
authors: G
authors: Mårtensson
authors: Ulla
authors: U
authors: Nyström
authors: Salmir
authors: S
authors: Nasic
authors: Rune
authors: R
authors: Andersson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D000998:Antiviral Agents / Q000627:therapeutic use*; D001989:Bronchiolitis Obliterans / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000187:drug effects / Q000302:isolation & purification / Q000502:physiology; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006084:Graft Rejection / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D012189:Retrospective Studies; D000077562:Valganciclovir; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir