An International Survey of Cytomegalovirus Management Practices in Lung Transplantation

Abstract

Although prophylaxis is the most commonly used preventive strategy, significant variation exists in the way it is implemented. Specifically, duration of prophylaxis is extremely variable. Uniform international guidelines would be of value in this population.

Long-term efficacy and safety of 12 months of valganciclovir prophylaxis compared with 3 months after lung transplantation: A single-center, long-term follow-up analysis from a randomized, controlled cytomegalovirus prevention trial

“…Although 3 months was standard practice at the time the valganciclovir study was initiated, clinical practice has evolved to include longer durations of prophylaxis, which at many centers is up to 6 months. 2 Despite this tendency toward increased prophylaxis to 6 months, no prospective randomized studies support this practice. One study suggested that valganciclovir prophylaxis courses extended through 180, 270, or 365 days postoperatively were all associated with low rates of CMV events during the next 180 days, however, this study was limited by the non-randomized study design, comparison with historical controls, and results were confounded by initial treatment with 30 to 90 days of IV ganciclovir and use of CMV hyperimmune globulin.…”

“…2,9 -11 A recent international survey, however, found that extending prophylaxis to 12 months is rare in clinical practice. 2 We recently completed a prospective, multicenter, randomized, placebocontrolled trial of CMV prevention in lung transplantation and demonstrated that extending prophylaxis to 1 year significantly reduced the incidence of CMV infection and disease during the first 18 months after transplant, without increasing ganciclovir resistance or adverse events compared with a shorter course of treatment. 3 In the current analysis, we leverage the previous randomized, prospective, double-blind clinical trial design and pa- Figure 1 Extended-course prophylaxis conferred a durable long-term cytomegalovirus protective benefit.…”

Polyfunctional T-Cell Signatures to Predict Protection from Cytomegalovirus after Lung Transplantation

“…Pretransplantation seropositive recipients represent the majority of transplantation recipients at risk for CMV, and current guidelines recommend a minimum of 6 months of antiviral prophylaxis for this cohort (1). However, due to the high cost of antiviral treatments (e.g., valganciclovir), risk of bone marrow suppression, and potential development of subsequent viral resistance, the optimal duration of prophylaxis is controversial, with practices varying across centers (6). Thus, there is an unmet clinical need to more precisely determine posttransplantation risk for CMV beyond pretransplantation recipient and donor serostatus, with the ultimate goal of tailoring CMV prophylaxis duration to an individual's specific risk.…”

CMV and transfusions, an old story that's not quite over yet

“…LR is considered sufficient, and CMV-seronegative blood is not required for SOT patients. 48,57 CMV disease in HIV-AIDS patients is a serious illness. Retinitis and gastrointestinal tract involvement are especially common.…”