title: Cytomegalovirus Immunoglobulin After Thoracic Transplantation: An Overview.
abstract: Cytomegalovirus (CMV) is a highly complex pathogen which, despite modern prophylactic regimens, continues to affect a high proportion of thoracic organ transplant recipients. The symptomatic manifestations of CMV infection are compounded by adverse indirect effects induced by the multiple immunomodulatory actions of CMV. These include a higher risk of acute rejection, cardiac allograft vasculopathy after heart transplantation, and potentially bronchiolitis obliterans syndrome in lung transplant recipients, with a greater propensity for opportunistic secondary infections. Prophylaxis for CMV using antiviral agents (typically oral valganciclovir or intravenous ganciclovir) is now almost universal, at least in high-risk transplants (D+/R-). Even with extended prophylactic regimens, however, challenges remain. The CMV events can still occur despite antiviral prophylaxis, including late-onset infection or recurrent disease, and patients with ganciclovir-resistant CMV infection or who are intolerant to antiviral therapy require alternative strategies. The CMV immunoglobulin (CMVIG) and antiviral agents have complementary modes of action. High-titer CMVIG preparations provide passive CMV-specific immunity but also exert complex immunomodulatory properties which augment the antiviral effect of antiviral agents and offer the potential to suppress the indirect effects of CMV infection. This supplement discusses the available data concerning the immunological and clinical effects of CMVIG after heart or lung transplantation.
authors.affiliation: 1 Department of Infectious and Tropical Diseases, University of Insubria, University Hopital Ospedale di Circolo-Fondazioni Macchi, Varese, Italy. 2 Department of Cardiology, Swiss Cardiovascular Center, University Hospital Bern, Switzerland. 3 Semmelweis University Heart and Vascular Center, Budapest, Hungary. 4 Heart and Lung Transplant Program, Cardiovascular Department, Academic Hospital Sant' Orsola Malpighi Bologna, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Grossi
authors.forename: Paul
authors.initials: P
authors.lastname: Mohacsi
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Szabolcs
authors.forename: Luciano
authors.initials: L
authors.lastname: Potena
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage*; D003245:Consensus Statements as Topic; D003587:Cytomegalovirus / Q000187:drug effects / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D015774:Ganciclovir / Q000008:administration & dosage / Q000031:analogs & derivatives; 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*; D016896:Treatment Outcome; D000077562:Valganciclovir; D014775:Virus Activation
chemical_list: D000998:Antiviral Agents; D007136:Immunoglobulins; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; C045781:cytomegalovirus-specific hyperimmune globulin; D000077562:Valganciclovir; D015774:Ganciclovir