Cytomegalovirus immunoglobulin decreases the risk of cytomegalovirus infection but not disease after pediatric lung transplantation.

Abstract

BACKGROUND:

Cytomegalovirus (CMV) has been associated with morbidity, including chronic allograft rejection, in transplant recipients. Data from adult centers suggests that CMV hyperimmune globulin (CMVIG) and ganciclovir together are superior in preventing CMV viremia than ganciclovir alone.

METHODS:

A retrospective review of pediatric lung transplant recipients at 14 sites in North America and Europe was conducted to evaluate the effect of adding cytomegalovirus immunoglobulin (CMVIG) prophylaxis to at least 3 weeks of intravenous ganciclovir therapy in pediatric lung transplant recipients. Data were recorded for the first year after transplantation. Associations between time to CMV and risk factors, including CMVIG use, were assessed by multivariable Cox proportional hazards models.

RESULTS:

Of 599 patients whose records were reviewed, 329 received at least 3 weeks of ganciclovir, with 62 (19%) receiving CMVIG. CMVIG was administered more frequently with CMV donor-positive/recipient-negative serostatus (p < 0.05). In multivariable models, patients who did not receive CMVIG as part of their prophylaxis were 3 times more likely to develop CMV infection (hazard ratio, 3.4; 95% confidence interval, 1.2-9.5) independent of CMV serostatus. However, CMVIG administration was not associated with decreased risk of episodes of CMV disease. Receipt of CMVIG was not associated with decreased risks of post-transplant morbidities (acute rejection, respiratory viral infection or early bronchiolitis obliterans) or morbidity within the first year after pediatric lung transplantation.

CONCLUSION:

The use of CMVIG in addition to antiviral prophylaxis in pediatric lung transplantation requires further evaluation.

• Authors: Kavitha Ranganathan, Sarah Worley, Marian G Michaels, Susana Arrigan, Paul Aurora, Manfred Ballmann, Debra Boyer, Carol Conrad, Irmgard Eichler, Okan Elidemir, Samuel Goldfarb, George B Mallory Jr, Peter J Mogayzel, Daiva Parakininkas, Melinda Solomon, Gary Visner, Stuart C Sweet, Albert Faro, Lara Danziger-Isakov
• Journal: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (J Heart Lung Transplant) Vol. 28 Issue 10 Pg. 1050-6 (Oct 2009) ISSN: 1557-3117 [Electronic] United States
• PMID: 19782286 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Antiviral Agents
• Immunoglobulins
• Immunoglobulins, Intravenous
• cytomegalovirus-specific hyperimmune globulin
• Ganciclovir

Topics

• Adolescent
• Antiviral Agents (therapeutic use)
• Bronchiolitis Obliterans (epidemiology)
• Child
• Child, Preschool
• Cytomegalovirus Infections (epidemiology, prevention & control)
• Dose-Response Relationship, Drug
• Drug Therapy, Combination
• Female
• Ganciclovir (therapeutic use)
• Graft Rejection (epidemiology)
• Humans
• Immunoglobulins (therapeutic use)
• Immunoglobulins, Intravenous
• Incidence
• Infant
• Lung Transplantation
• Male
• Proportional Hazards Models
• Retrospective Studies
• Risk Factors
• Viremia (epidemiology, prevention & control)
• Young Adult