Cytomegalovirus disease is associated with higher all-cause mortality after lung transplantation despite extended antiviral prophylaxis

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Abstract

Background: The duration of anticytomegalovirus (CMV) prophylaxis after lung transplantation (LT) varies among transplant centers. Methods: A retrospective review of CMV donor-seropositive/recipient-seronegative (D+/R-) and CMV recipient-seropositive (R+) LT patients between January 2005 and September 2012 was performed. Starting January 2007, valganciclovir prophylaxis was given for at least 12 months (often lifelong) for CMV D+/R- and extended from three to six months for R+ LT patients. Risks of CMV infection and CMV disease, and mortality after LT, were assessed. Results: A total of 88 LT patients were studied, including 32 CMV D+/R-, and 56 R+ patients. During the follow-up period, 11 (12.5%) patients had asymptomatic CMV infection, and nine (10.3%) developed CMV disease. CMV disease (HR, 4.189; 95% CI: 1.672-10.495; p = 0.002) and CMV infection and disease (HR, 3.775; 95% CI: 1.729-8.240; p = 0.001) were significant risk factors for mortality. Overall, no significant difference was observed in rates of CMV infection or disease among LT recipients who received shorter vs. extended CMV prophylaxis. Conclusions: Despite extended prophylaxis, LT patients remain at risk of CMV infection and disease. CMV remains associated with increased mortality after transplantation.

Original languageEnglish (US)
Pages (from-to)270-278
Number of pages9
JournalClinical Transplantation
Volume30
Issue number3
DOIs
StatePublished - Mar 1 2016

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Lung Transplantation
Cytomegalovirus
Antiviral Agents
Mortality
Infection
Asymptomatic Infections
Transplantation
Tissue Donors
Transplants

Keywords

  • Cytomegalovirus
  • Extended prophylaxis
  • Lung transplant

ASJC Scopus subject areas

  • Transplantation

Cite this

@article{9a2b8737b01b4b6a88f79cd3ff4b4ffb,
title = "Cytomegalovirus disease is associated with higher all-cause mortality after lung transplantation despite extended antiviral prophylaxis",
abstract = "Background: The duration of anticytomegalovirus (CMV) prophylaxis after lung transplantation (LT) varies among transplant centers. Methods: A retrospective review of CMV donor-seropositive/recipient-seronegative (D+/R-) and CMV recipient-seropositive (R+) LT patients between January 2005 and September 2012 was performed. Starting January 2007, valganciclovir prophylaxis was given for at least 12 months (often lifelong) for CMV D+/R- and extended from three to six months for R+ LT patients. Risks of CMV infection and CMV disease, and mortality after LT, were assessed. Results: A total of 88 LT patients were studied, including 32 CMV D+/R-, and 56 R+ patients. During the follow-up period, 11 (12.5{\%}) patients had asymptomatic CMV infection, and nine (10.3{\%}) developed CMV disease. CMV disease (HR, 4.189; 95{\%} CI: 1.672-10.495; p = 0.002) and CMV infection and disease (HR, 3.775; 95{\%} CI: 1.729-8.240; p = 0.001) were significant risk factors for mortality. Overall, no significant difference was observed in rates of CMV infection or disease among LT recipients who received shorter vs. extended CMV prophylaxis. Conclusions: Despite extended prophylaxis, LT patients remain at risk of CMV infection and disease. CMV remains associated with increased mortality after transplantation.",
keywords = "Cytomegalovirus, Extended prophylaxis, Lung transplant",
author = "E. Beam and T. Lesnick and Kremers, {Walter K} and Cassie Kennedy and Razonable, {Raymund R}",
year = "2016",
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doi = "10.1111/ctr.12686",
language = "English (US)",
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pages = "270--278",
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T1 - Cytomegalovirus disease is associated with higher all-cause mortality after lung transplantation despite extended antiviral prophylaxis

AU - Beam, E.

AU - Lesnick, T.

AU - Kremers, Walter K

AU - Kennedy, Cassie

AU - Razonable, Raymund R

PY - 2016/3/1

Y1 - 2016/3/1

N2 - Background: The duration of anticytomegalovirus (CMV) prophylaxis after lung transplantation (LT) varies among transplant centers. Methods: A retrospective review of CMV donor-seropositive/recipient-seronegative (D+/R-) and CMV recipient-seropositive (R+) LT patients between January 2005 and September 2012 was performed. Starting January 2007, valganciclovir prophylaxis was given for at least 12 months (often lifelong) for CMV D+/R- and extended from three to six months for R+ LT patients. Risks of CMV infection and CMV disease, and mortality after LT, were assessed. Results: A total of 88 LT patients were studied, including 32 CMV D+/R-, and 56 R+ patients. During the follow-up period, 11 (12.5%) patients had asymptomatic CMV infection, and nine (10.3%) developed CMV disease. CMV disease (HR, 4.189; 95% CI: 1.672-10.495; p = 0.002) and CMV infection and disease (HR, 3.775; 95% CI: 1.729-8.240; p = 0.001) were significant risk factors for mortality. Overall, no significant difference was observed in rates of CMV infection or disease among LT recipients who received shorter vs. extended CMV prophylaxis. Conclusions: Despite extended prophylaxis, LT patients remain at risk of CMV infection and disease. CMV remains associated with increased mortality after transplantation.

AB - Background: The duration of anticytomegalovirus (CMV) prophylaxis after lung transplantation (LT) varies among transplant centers. Methods: A retrospective review of CMV donor-seropositive/recipient-seronegative (D+/R-) and CMV recipient-seropositive (R+) LT patients between January 2005 and September 2012 was performed. Starting January 2007, valganciclovir prophylaxis was given for at least 12 months (often lifelong) for CMV D+/R- and extended from three to six months for R+ LT patients. Risks of CMV infection and CMV disease, and mortality after LT, were assessed. Results: A total of 88 LT patients were studied, including 32 CMV D+/R-, and 56 R+ patients. During the follow-up period, 11 (12.5%) patients had asymptomatic CMV infection, and nine (10.3%) developed CMV disease. CMV disease (HR, 4.189; 95% CI: 1.672-10.495; p = 0.002) and CMV infection and disease (HR, 3.775; 95% CI: 1.729-8.240; p = 0.001) were significant risk factors for mortality. Overall, no significant difference was observed in rates of CMV infection or disease among LT recipients who received shorter vs. extended CMV prophylaxis. Conclusions: Despite extended prophylaxis, LT patients remain at risk of CMV infection and disease. CMV remains associated with increased mortality after transplantation.

KW - Cytomegalovirus

KW - Extended prophylaxis

KW - Lung transplant

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