Combined Cytomegalovirus Prophylaxis in Lung Transplantation: Effects on Acute Rejection, Lymphocytic Bronchitis/Bronchiolitis, and Herpesvirus Infections

Solidoro, Paolo; Libertucci, Daniela; Delsedime, Luisa; Ruffini, Enrico; Bosco, Martino; Costa, Cristina; Rinaldi, Mauro; Baldi, S.

doi:10.1016/j.transproceed.2008.05.028

Cited by 28 publications

(24 citation statements)

References 4 publications

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“…It is not clear if this effect is either just direct, mainly IG mediated, as can be supposed by the efficacy in 3,6,9,12 months TBB when CMV-IG were the only administered prophylaxis or, at least in part, indirect related to a reduction of the number of AR and LB, as already demonstrated (20). C) Vaccination -The live attenuated CMV Towne strain vaccine has not been tested in lung transplantation.…”

Section: © C I C E D I Z I O N I I N T E R N a Z I O N A L Imentioning

confidence: 98%

“…Although D+/R+ patients are discussed here together with the D-/R+ group, the former group is typically at higher risk for developing CMV disease (84). B) Passive immunoprophylaxis: prophylaxis with CMV hyperimmune globulin or with polyvalent unselected immunoglobulin appears to be beneficial following kidney and liver transplantation and is used at some lung transplant centers (20,85,86). A retrospective study compared prophylaxis with ganciclovir plus CMV immune globulins in a contemporary group of lung and heart-lung recipients with prophylaxis with ganciclovir alone in a group of historical controls at the same center (87).…”

Section: © C I C E D I Z I O N I I N T E R N a Z I O N A L Imentioning

confidence: 99%

“…Adequately powered, randomized trials measuring the additive benefit of CMV immune globulin in the lung transplant population have not yet been performed. The role of combined CMV prophylaxis on herpes virus infections, acute rejection and lymphocytic bronchitis/bronchiolitis has been investigated in the first year following lung transplantation in 46 patients (20). In the study group (combined prophylaxis) the number of episodes of A2 (mild) and A3 (moderate) acute rejections (AR), needing pulse steroids therapy and Lymphocytic Bronchitis (LB), a risk factor for chronic rejection, were significantly lower than in the control group: 6% (5/73) vs 17% (19/107), p=0.04 and 2% (2/73) vs 11% (12/107), p=0.04, respectively.…”

Section: © C I C E D I Z I O N I I N T E R N a Z I O N A L Imentioning

confidence: 99%

“…A logistic regression analysis was performed using the presence/absence of AR as dependent variable and combined CMV prophylaxis, LB, OB, CMV pneumonia as independent variables. The result was a strong significant relationship between combined CMV prophylaxis and reduction in prevalence of AR (OR 3.25, CI 1.12-9.40, p0.03) (20). Intravenous immunoglobulins (IVIg) have anti-inflammatory properties and are commonly used for the treatment of autoimmune and systemic inflammatory diseases (88,89).…”

Section: © C I C E D I Z I O N I I N T E R N a Z I O N A L Imentioning

confidence: 99%

“…Most immunosuppressive and anti-infective drugs have only been proven for safety and efficacy in kidney or liver transplant recipients. Therefore, no clear recommendations concerning prophylactic regimen and dosage in cardiothoracic transplantation are available from the companies distributing CMV-IG (19,20). In the following pages we'll try to review the role CMV on lung transplantation and the possible best approach to its management.…”

Section: Introductionmentioning

confidence: 99%

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CMV management in lung transplant recipients

Solidoro¹,

Costa²,

Libertucci³

et al. 2014

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recipients management relative to the mortality and morbidity and, on the other hand, to the availability of effective antiviral agents as well as new diagnostic techniques and the prophylaxis, diagnosis, and treatment of CMV infections. In lung transplant recipients management is evolving with experience and we are living the sunrise of a new personalized or tailored management era matching, almost in real time, infection, diagnosis, immunity status and therapy. KEY WORDS: CMV infection, lung transplant, acute rejection, chronic rejection, hyperimmune globulins. IntroductionCytomegalovirus (CMV), a member of the beta herpes virus group, causes a spectrum of disorders, which includes serious illness in organ transplant recipients (1-4). Its presence in biological specimens and its role in co-infections and rejection is far to be fully defined. It is the second most common infection among lung transplant recipients, after bacterial pneumonia (5, 6), and is associated with significant morbidity and mortality after transplantation. Although the availability of effective antiviral drugs has decreased CMV-related mortality, the attention in last years has been addressed to its immunobiological role: in fact CMV infections or pneumonia have been associated to chronic rejection (bronchiolitis obliterans syndrome, BOS) in some, but not all, studies (7,8). The endothelium represents the anatomical and functional interface between engrafted donor tissue and the host immune system and interacts dynamically in immunomodulation. This implies an important role for the endothelial cell (EC) in the initiation, maintenance and/or termination of immune interactions affecting the fate of allograft (9). CMV does not directly induce HLA class II on infected human EC, but the rejection associated class II induction within the allograft might be a consequence of IFN-gamma release by activated T CD4+ cells in response to CMV infection (10).

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Section: © C I C E D I Z I O N I I N T E R N a Z I O N A L Imentioning

confidence: 98%