title: CMV Immunoglobulins for the Treatment of CMV Infections in Thoracic Transplant Recipients.
abstract: Intravenous ganciclovir and, increasingly, oral valganciclovir are now considered the mainstay of treatment for cytomegalovirus (CMV) infection or CMV disease. Under certain circumstances, CMV immunoglobulin (CMVIG) may be an appropriate addition or, indeed, alternative. Data on monotherapy with CMVIG are limited, but encouraging, for example in cases of ganciclovir intolerance. In cases of recurrent CMV in thoracic transplant patients after a disease- and drug-free period, adjunctive CMVIG can be considered in patients with hypogammaglobulinemia. Antiviral-resistant CMV, which is more common among thoracic organ recipients than in other types of transplant, can be an indication for introduction of CMVIG, particularly in view of the toxicity associated with other options, such as foscarnet. Due to a lack of controlled trials, decision-making is based on clinical experience. In the absence of a robust evidence base, it seems reasonable to consider the use of CMVIG to treat CMV in adult or pediatric thoracic transplant patients with ganciclovir-resistant infection, or in serious or complicated cases. The latter can potentially include (i) treatment of severe clinical manifestations, such as pneumonitis or eye complications; (ii) patients with a positive biopsy in end organs, such as the lung or stomach; (iii) symptomatic cases with rising polymerase chain reaction values (for example, higher than 5.0 log10) despite antiviral treatment; (iv) CMV disease or CMV infection or risk factors, such as CMV-IgG-negative serostatus; (vi) ganciclovir intolerance; (vii) patients with hypogammaglobulinemia.
authors.affiliation: 1 Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany. 2 Cardiovascular and Thoracic Department, Lung Diseases Unit, A.O.U. Citta della Salute e della Scienza di Torino, Turin, Italy. 3 Department of Pulmonolgy, Semmelweis University, Budapest, Hungary. 4 Department of Pediatrics, Semmelweis University, Budapest, Hungary. 5 Department of Pneumology, Hannover Medical School, Hannover, Germany. 6 Department of Internal Medicine V-Saarland University Medical Center Homburg/Saar, Germany. 7 Clinic for Cardiology, University Heart Center, University Hospital Zürich, Zürich, Switzerland.
authors.forename: Uwe
authors.initials: U
authors.lastname: Schulz
authors.forename: Paolo
authors.initials: P
authors.lastname: Solidoro
authors.forename: Veronika
authors.initials: V
authors.lastname: Müller
authors.forename: Attila
authors.initials: A
authors.lastname: Szabo
authors.forename: Jens
authors.initials: J
authors.lastname: Gottlieb
authors.forename: Heinrike
authors.initials: H
authors.lastname: Wilkens
authors.forename: Frank
authors.initials: F
authors.lastname: Enseleit
mesh_terms: D000328:Adult; D000361:Agammaglobulinemia / Q000276:immunology; D000998:Antiviral Agents / Q000008:administration & dosage; D003587:Cytomegalovirus / Q000187:drug effects / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D024882:Drug Resistance, Viral; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D054884:Host-Pathogen Interactions; D006801:Humans; D007116:Immunization, Passive; D016867:Immunocompromised Host; D007136:Immunoglobulins / Q000008:administration & dosage* / Q000009:adverse effects; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016040:Lung Transplantation / Q000009:adverse effects*; D009894:Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome; D014775:Virus Activation
chemical_list: D000998:Antiviral Agents; D007136:Immunoglobulins; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; C045781:cytomegalovirus-specific hyperimmune globulin