Cytomegalovirus viremia in lung transplantation during and after prophylaxis
| Autor: | Andrew Chang, Jeremy P. Wrobel, Peter Boan, Michael Musk, Meow-Chong Yaw, Sharon Lawrence, Shiji Chirayath, Melanie Lavender |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Congenital cytomegalovirus infection Bronchiolitis obliterans Cytomegalovirus Viremia 030230 surgery Gastroenterology Antiviral Agents 03 medical and health sciences 0302 clinical medicine Median follow-up Internal medicine medicine Lung transplantation Humans Valganciclovir Ganciclovir Transplantation business.industry Incidence (epidemiology) Incidence Australia virus diseases Middle Aged Viral Load medicine.disease Infectious Diseases Cytomegalovirus Infections lipids (amino acids peptides and proteins) 030211 gastroenterology & hepatology Female business Viral load medicine.drug Lung Transplantation |
| Zdroj: | Transplant infectious disease : an official journal of the Transplantation Society. 21(3) |
| ISSN: | 1399-3062 |
| Popis: | Background Lung transplantation has a high risk of cytomegalovirus (CMV) viremia and disease. Methods Valganciclovir was planned for 6 months in CMV recipient seropositive (R+) lung transplants (LTs) and given long-term in D+R- LTs. CMV viremia was monitored regularly during and after prophylaxis in all patients. Results Of 137 LTs, 22 were D+R-, 49 D+R+, 43 D-R+, and 23 D-R-, with median follow up 4.1 years (IQR 2.1-6.2 years). CMV viremia at any time occurred in 44.5% of LTs. CMV viral load >103 c/mL was uncommon (9/77 episodes). CMV viremia occurred at median 665 days (IQR 271-1411 days), in 5.1% LTs 12 months. CMV disease occurred in 6 (4.4%) LTs at an overall rate of 1.0 episode per 100 person-years: two of these cases were organ-specific disease, four were CMV syndrome. One case of ganciclovir-resistant CMV was diagnosed. D+R+ and D+R- LTs had higher viremia rates than the D-R+ group. No viremia occurred in D-R- LTs. CMV viremia was not associated with age, gender, type of LT, indication for LT, acute rejection, bronchiolitis obliterans syndrome, or mortality. Conclusions Prophylaxis for 6 months in D+R+ and D-R+, and past 12 months in D+R- LTs, with long-term monitoring in all patients using a sensitive assay, and reinstitution of valganciclovir for low-level viremia was effective at markedly reducing the incidence of CMV disease. CMV D-R- LTs do not need routine CMV monitoring. |
| Databáze: | OpenAIRE |
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