Abstract | BACKGROUND: MATERIAL AND METHODS: At-risk patients (donor seropositive/recipient seronegative [D+/R-] and R+) received valganciclovir for 3 months (R+) or 6 months (D+/R). CMVIg (2 mg/kg) was given to D+/R- patients on days 1, 4, 8, 15, and 30 post-transplant, then monthly for a further year. Patients with valganciclovir-induced leukopenia were switched to CMVIg (2 mg/kg) prophylaxis. Tissue-invasive disease was treated with intravenous ganciclovir with CMVIg (2 mg/kg) every other day for 1 week and then weekly until discharge. RESULTS: Of 159 patients analyzed, 26 (17%) were D+/R-. Cytomegalovirus (CMV) viremia was more frequent in D+/R- recipients than in R+ patients (61% vs. 35%; P<0.05), but developed at a similar time (mean 10±6 vs. 11±7 months) and resolved in all cases following treatment. One patient developed clinical and laboratory signs of CMV syndrome ( fever >38°C), leukopenia, and detection of CMV in blood. Ten patients developed tissue-invasive disease after completion of prophylaxis (5 pneumonitis and 5 gastrointestinal disease); all were successfully treated with combined intravenous ganciclovir and CMVIg. None of the 18 donor seropositive/recipient seronegative patients who were switched from valganciclovir to CMVIg for persistent leukopenia developed CMV viremia during treatment. No cases of CMV infection or disease were attributable to ganciclovir-resistant strains. During follow-up, 44 patients died (4/26 R+/D- [15%], 40/133 R+ [30%), none directly due to CMV infection. CONCLUSIONS: Combined prophylaxis with valganciclovir and CMVIg delayed CMV viremia and tissue-invasive disease in D+/R- lung transplant recipients, and prevented CMV-related mortality and development of ganciclovir resistance. CMVIg monotherapy prophylaxis was effective in R+ patients with ganciclovir-related toxicity.
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Authors | Cristina Lopez Garcia-Gallo, Christian García Fadul, Rosalia Laporta, Francisca Portero, Isabel Millan, Piedad Ussetti |
Journal | Annals of transplantation
(Ann Transplant)
Vol. 20
Pg. 661-6
(Nov 05 2015)
ISSN: 2329-0358 [Electronic] United States |
PMID | 26537426
(Publication Type: Journal Article)
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Chemical References |
- Antiviral Agents
- Immunoglobulins
- Immunoglobulins, Intravenous
- cytomegalovirus-specific hyperimmune globulin
- Valganciclovir
- Ganciclovir
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Topics |
- Adolescent
- Adult
- Aged
- Antiviral Agents
(therapeutic use)
- Cytomegalovirus Infections
(drug therapy, prevention & control)
- Female
- Ganciclovir
(analogs & derivatives)
- Graft Rejection
(prevention & control)
- Humans
- Immunoglobulins
(therapeutic use)
- Immunoglobulins, Intravenous
- Lung Transplantation
- Male
- Middle Aged
- Retrospective Studies
- Treatment Outcome
- Valganciclovir
- Young Adult
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