title: Cytomegalovirus disease is associated with higher all-cause mortality after lung transplantation despite extended antiviral prophylaxis.
abstract: BACKGROUND
  The duration of anticytomegalovirus (CMV) prophylaxis after lung transplantation (LT) varies among transplant centers.
  
  
  METHODS
  A retrospective review of CMV donor-seropositive/recipient-seronegative (D+/R-) and CMV recipient-seropositive (R+) LT patients between January 2005 and September 2012 was performed. Starting January 2007, valganciclovir prophylaxis was given for at least 12 months (often lifelong) for CMV D+/R- and extended from three to six months for R+ LT patients. Risks of CMV infection and CMV disease, and mortality after LT, were assessed.
  
  
  RESULTS
  A total of 88 LT patients were studied, including 32 CMV D+/R-, and 56 R+ patients. During the follow-up period, 11 (12.5%) patients had asymptomatic CMV infection, and nine (10.3%) developed CMV disease. CMV disease (HR, 4.189; 95% CI: 1.672-10.495; p = 0.002) and CMV infection and disease (HR, 3.775; 95% CI: 1.729-8.240; p = 0.001) were significant risk factors for mortality. Overall, no significant difference was observed in rates of CMV infection or disease among LT recipients who received shorter vs. extended CMV prophylaxis.
  
  
  CONCLUSIONS
  Despite extended prophylaxis, LT patients remain at risk of CMV infection and disease. CMV remains associated with increased mortality after transplantation.
authors.affiliation: Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: E
authors.initials: E
authors.lastname: Beam
authors.affiliation: Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: T
authors.initials: T
authors.lastname: Lesnick
authors.affiliation: Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, USA.|The William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: W
authors.initials: W
authors.lastname: Kremers
authors.affiliation: The William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic College of Medicine, Rochester, MN, USA.|Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: C C
authors.initials: CC
authors.lastname: Kennedy
authors.affiliation: Infectious Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA.|Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: R R
authors.initials: RR
authors.lastname: Razonable
mesh_terms: D019072:Antibiotic Prophylaxis; D000998:Antiviral Agents / Q000494:pharmacology*; D003587:Cytomegalovirus / Q000187:drug effects*; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality* / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D015774:Ganciclovir / Q000031:analogs & derivatives* / Q000494:pharmacology; D006084:Graft Rejection / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality* / Q000821:virology; D006085:Graft Survival; D006801:Humans; D008171:Lung Diseases / Q000601:surgery*; D016040:Lung Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D011183:Postoperative Complications; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D000077562:Valganciclovir
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir
keywords: cytomegalovirus; extended prophylaxis; lung transplant