A comparison of ganciclovir and acyclovir to prevent cytomegalovirus after lung transplantation.

Abstract

In an attempt to modify the sequelae of cytomegalovirus (CMV) infections after lung transplantation, 25 allograft recipients were randomized to either ganciclovir 5 mg/kg once a day 5 d/wk (Group G) or acyclovir 800 mg four times a day (Group A). All subjects received ganciclovir during postoperative Weeks 1 through 3, and they were then given either A or G regimens until Day 90. At termination of study enrollment, the cumulative incidence of all CMV infections (including seroconversions) was increased in Group A compared with that in Group G (75% versus 15%, p < 0.01), as was the incidence of overt CMV shedding and/or pneumonitis (50% versus 15%, p < 0.043). In comparison with those in Group G, subjects in Group A were also afflicted with an increased prevalence of obliterative bronchiolitis (OB) during the first year after transplantation (54% versus 17%, p < 0.033). Intravenous catheters for ganciclovir administration resulted in four complications among three of the subjects in Group G (23%). The short-term benefits of ganciclovir were ultimately limited, moreover, in that cumulative rates of CMV and prevalence of OB are now similar in both treatment groups after approximately 2 yr of observation. We conclude that prolonged ganciclovir prophylaxis decreases the early incidence of CMV and OB among lung transplant recipients, but these effects are of finite duration. Although CMV prevention appears to have considerable potential value in this population, definitive viral prophylaxis will require development of protracted or repeated treatment regimens, or longer-acting agents.

Post-transplant bronchiolitis obliterans

“…However, the impact of CMV on the development of BOS remains controversial, possibly due to several factors, such as the matching of CMV-seronegative recipients with CMVseronegative donors, the prospective monitoring of CMV antigenaemia as a surveillance technique for CMV infection, the use of prophylactic or pre-emptive antiviral treatments and changes in the immunosuppressive regimen, all of which may mask potential associations [44]. Several centres have reported a decreased risk of CMV in the development of BOS, either a decreased incidence or a delayed onset, after the use of CMV prophylaxis [45][46][47].…”

New Strategies for Prevention and Therapy of Cytomegalovirus Infection and Disease in Solid-Organ Transplant Recipients

“…Current prophylactic approaches vary widely among different transplant programs (5,8,18,26,72,104,105,143,145,172,232,236,273,284,299,319,382,396,423,497) (Table 5). Reasons for the discrepancies reflect the absence of large, multicenter, randomized trials evaluating the efficacy of countless preventive strategies.…”

Following Universal Prophylaxis with Intravenous Ganciclovir and Cytomegalovirus Immune Globulin, Valganciclovir is Safe and Effective for Prevention of CMV Infection Following Lung Transplantation

“…Several prophylactic regimens have been studied in lung transplant recipients, including i.v. and oral GCV alone or in combination with CMV hyperimmune globulin (CMV-IVIG) (7)(8)(9)(10)(11)(12). However, the optimal prophylactic strategy in lung transplant recipients remains controversial; the appropriate regimen and duration of therapy remains unclear.…”