title: Risk factors, survival, and impact of prophylaxis length in cytomegalovirus-seropositive lung transplant recipients: A prospective, observational, multicenter study.
abstract: BACKGROUND
  The optimal length of cytomegalovirus (CMV) prophylaxis in lung transplantation according to CMV serostatus is not well established.
  
  
  METHODS
  We have performed a prospective, observational, multicenter study to determine the incidence of CMV infection and disease in 92 CMV-seropositive lung transplant recipients (LTR), their related outcomes and risk factors, and the impact of prophylaxis length.
  
  
  RESULTS
  At 18 months post transplantation, 37 patients (40%) developed CMV infection (23 [25%]) or disease (14 [15.2%]). Overall mortality was higher in patients with CMV disease (64.3% vs 10.2%; P<.001), but only one patient died from CMV disease. In the multivariate analysis, CMV disease was an independent death risk factor (odds ratio [OR] 18.214, 95% confidence interval [CI] 4.120-80.527; P<.001). CMV disease incidence was higher in patients with 90-day prophylaxis than in those with 180-day prophylaxis (31.3% vs 11.8%; P=.049). Prophylaxis length was an independent risk factor for CMV disease (OR 4.974, 95% CI 1.231-20.094; P=.024). Sixteen patients withdrew from prophylaxis because of adverse events.
  
  
  CONCLUSIONS
  CMV infection and disease in CMV-seropositive LTR remain frequent despite current prophylaxis. CMV disease increases mortality, whereas 180-day prophylaxis reduces the incidence of CMV disease.
authors.affiliation: Respiratory Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.|Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Victor
authors.initials: V
authors.lastname: Monforte
authors.affiliation: Respiratory Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.|Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Helena
authors.initials: H
authors.lastname: Sintes
authors.affiliation: Respiratory Department, Hospital Puerta de Hierro, Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: López-Gallo
authors.affiliation: Thoracic Surgery Department, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Delgado
authors.affiliation: Respiratory Department, Hospital Reina Sofía, Córdoba, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Santos
authors.affiliation: Respiratory Department, Hospital Marqués de Valdecilla, Santander, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Zurbano
authors.affiliation: Respiratory Department, Hospital La Fe, Valencia, Spain.
authors.forename: Amparo
authors.initials: A
authors.lastname: Solé
authors.affiliation: Infectious Disease Department, Hospital Universitari Vall d'Hebrón, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Gavaldá
authors.affiliation: Thoracic Surgery Department, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain.
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Borro
authors.affiliation: Respiratory Department, Hospital Reina Sofía, Córdoba, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Redel-Montero
authors.affiliation: Respiratory Department, Hospital Marqués de Valdecilla, Santander, Spain.
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Cifrian
authors.affiliation: Respiratory Department, Hospital La Fe, Valencia, Spain.
authors.forename: Amparo
authors.initials: A
authors.lastname: Pastor
authors.affiliation: Respiratory Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.|Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Román
authors.affiliation: Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.|Respiratory Department, Hospital Puerta de Hierro, Madrid, Spain.
authors.forename: Piedad
authors.initials: P
authors.lastname: Ussetti
mesh_terms: D000328:Adult; D019072:Antibiotic Prophylaxis / Q000379:methods / Q000592:standards; D000998:Antiviral Agents / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000097:blood / Q000453:epidemiology* / Q000517:prevention & control* / Q000821:virology; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008171:Lung Diseases / Q000401:mortality / Q000601:surgery*; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012307:Risk Factors; D012698:Serologic Tests; D013997:Time Factors; D066027:Transplant Recipients / Q000706:statistics & numerical data; D000077562:Valganciclovir; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D000077562:Valganciclovir; D015774:Ganciclovir
keywords: cytomegalovirus; ganciclovir; lung transplantation; prophylaxis; valganciclovir