Early diagnosis and effective treatment of pulmonary CMV infection after lung transplantation.

• Abstract: The early diagnosis and effective treatment of cytomegalovirus (CMV) pneumonia remains a keystone for patient survival after lung transplantation. At present, the use of DHPG (ganciclovir sodium) opens the possibility of a potent antiviral therapy. The use of monoclonal antibodies directed to immediate early CMV antigens offers a fast method to detect the early phase of systemic or local viral replication. Five single lung and heart-lung transplant patients at high risk for CMV infection (donor, CMV-positive; recipient, CMV-negative) were monitored by cellular immunohistology for immediate early antigens. Specimens from bronchoalveolar lavage (n = 39) and bronchial biopsies (n = 17), and peripheral blood leukocytes (n = 57) were examined. In peripheral blood leukocytes and bronchial biopsy specimens no CMV-positive cells were detected. The bronchoalveolar lavage analysis of two patients showed immediate early antigen-positive cells after 1 to 3 months. At the same time the patients had clinical symptoms that could also be related to lung rejection. Serologic conversion (CMV-IgM) occurred only 6 days later in one patient with informative follow-up analysis; CMV culture (available 4 to 6 weeks later) confirmed the diagnosis retrospectively. DHPG treatment was started immediately and resulted in CMV antigen negativity in bronchoalveolar lavage fluid after one or two courses (10 mg/kg/day; 14 days). Direct antigen detection offers a fast and specific monitoring of early CMV infection. The implications to the clinical management of lung transplant patients are discussed.
• Authors: G Steinhoff, M Behrend, T O Wagner, M H Höper, A Haverich (Affiliation: Center of Surgery and Internal Medicine, Medical School Hannover, F.R.G.)
• Journal: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (J Heart Lung Transplant) 1991 Jan-Feb Vol. 10 Issue 1 Pt 1 Pg. 9-14 ISSN: 1053-2498 [Print] UNITED STATES
• PMID: 1848789 (Publication Type: Journal Article)

Chemical References

• Antibodies, Monoclonal
• Antigens, Viral
• Ganciclovir

Topics

• Adult
• Antibodies, Monoclonal (diagnostic use)
• Antigens, Viral (analysis)
• Bronchoalveolar Lavage Fluid (cytology)
• Cytomegalovirus (immunology)
• Cytomegalovirus Infections (diagnosis, therapy)
• Female
• Ganciclovir (therapeutic use)
• Heart-Lung Transplantation
• Humans
• Immunization, Passive
• Lung Transplantation
• Male
• Pneumonia, Viral (diagnosis, therapy)