title: Cytomegalovirus Hyper Immunoglobulin for CMV Prophylaxis in Thoracic Transplantation.
abstract: Cytomegalovirus (CMV) infection negatively influences both short- and long-term outcomes after cardiothoracic transplantation. In heart transplantation, registry analyses have shown that CMV immunoglobulin (CMVIG) with or without virostatic prophylaxis is associated with a significant reduction in mortality and graft loss versus no prophylaxis, particularly in high-risk donor (D)+/recipient (R)- transplants. Randomized comparative trials are lacking but retrospective data suggest that addition of CMVIG to antiviral prophylaxis may reduce rates of CMV-related events after heart transplantation, including the incidence of acute rejection or chronic allograft vasculopathy. However, available data consistently indicate that when CMVIG is used, it should be administered with concomitant antiviral therapy, and that evidence concerning preemptive management with CMVIG is limited, but promising. In lung transplantation, CMVIG should again only be used with concomitant antiviral therapy. Retrospective studies have shown convincing evidence that addition of CMVIG to antiviral prophylaxis lowers CMV endpoints and mortality. The current balance of evidence suggests that CMVIG prophylaxis reduces the risk of bronchiolitis obliterans syndrome, but a controlled trial is awaited. Overall, the relatively limited current data set suggests that prophylaxis with CMVIG in combination with antiviral therapy appears effective in D+/R- heart transplant patients, whereas in lung transplantation, addition of CMVIG in recipients of a CMV-positive graft may offer an advantage in terms of CMV infection and disease.
authors.affiliation: 1 Thoracic Surgical Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy. 2 Heart and Lung Transplant Program, Cardiovascular Department, Academic Hospital Sant' Orsola Malpighi Bologna, Bologna, Italy. 3 Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester, United Kingdom. 4 Department of Cardiovascular Surgery, Hamburg University Heart Center, Hamburg, Germany. 5 Thoracic Pathology Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Rea
authors.forename: Luciano
authors.initials: L
authors.lastname: Potena
authors.forename: Nizar
authors.initials: N
authors.lastname: Yonan
authors.forename: Florian
authors.initials: F
authors.lastname: Wagner
authors.forename: Fiorella
authors.initials: F
authors.lastname: Calabrese
mesh_terms: 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*; 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*; D012042:Registries; D013997:Time 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