Cytomegalovirus disease among donor-positive/recipient-negative lung transplant recipients in the era of valganciclovir prophylaxis

A polymorphism linked to elevated levels of interferon-γ is associated with an increased risk of cytomegalovirus disease among Caucasian lung transplant recipients at a single center

“…Extrapolations beyond this population may not be valid. As a result of the present study and a recent report from our center, 45 we have extended the duration of valganciclovir prophylaxis to at least 12 months for D ϩ /R Ϫ lung transplant recipients. To better understand the implications of our IFN-␥ SNP data, we are monitoring CMV-specific T-cell responses among CMV R ϩ patients after transplantation and assessing associations with clinical events.…”

Ganciclovir-Resistant Cytomegalovirus Infections among Lung Transplant Recipients Are Associated with Poor Outcomes despite Treatment with Foscarnet-Containing Regimens

“…Controversy persists, however, over the recommended duration of valganciclovir prophylaxis. Several reports, including one from our program, demonstrated that courses Ն6 months are superior to shorter courses (8,14,19). More recently, a multicenter study of 136 lung transplant recipients showed that valganciclovir prophylaxis for 12 months significantly reduced active infections compared to a 3-month course (17).…”

“…Overall, ganciclovir-resistant CMV has been reported in 0 to 15% of lung transplant recipients who develop active infections (17,(19)(20)(21)(22)(23)(24). Genotypic resistance stems from mutations at hot spots in the UL97 gene, which encodes the viral DNA phosphotransferase that monophosphorylates ganciclovir, and/or the UL54 gene, which encodes viral DNA polymerase (25).…”

Update on lung transplantation: programmes, patients and prospects

“…However, with the use of more tailored immunosuppression protocols, the increased availability of antiviral agents for prophylaxis and treatment protocols and the development of better molecularbased diagnostic tools to help guide pre-emptive intervention strategies, the rates of clinical CMV disease syndromes (including CMV pneumonitis) have reduced dramatically and the focus is now on how to best understand and therefore manage subclinical CMV reactivation [167][168][169][170][171][172][173][174].…”

“…Although this extended approach has had the overall benefit of reducing CMV events in LTR, late CMV can still occur [172,173,184,185] thereby raising the possibility that longterm prophylaxis may have additional benefits [183,185,186]. However, longer use of antiviral drugs will need to be balanced against the potential for increased toxicity, antiviral resistance and increased costs.…”