Extended Valganciclovir Prophylaxis to Prevent Cytomegalovirus After Lung Transplantation

Palmer, Scott M.; Limaye, Ajit P.; Banks, Missy; Gallup, Dianne; Chapman, Jeffrey T.; Lawrence, E. Clinton; Dunitz, Jordan M.; Milstone, Aaron P.; Reynolds, John M.; Yung, Gordon; Chan, Kevin M.; Aris, Robert M.; Garrity, Edward R.; Valentine, Vincent G.; McCall, Jonathan; Chow, Shein Chung; Davis, Robert D.; Avery, Robin K.

doi:10.7326/0003-4819-152-12-201006150-00003

Cited by 224 publications

(209 citation statements)

References 28 publications

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“…CMV disease incidence was 16.9% in high-risk patients (CMV Dþ/RÀ) and 4.4% in the intermediate-risk patients (CMV Rþ). These numbers are similar to or lower than those observed in the most recent published prospective cohort studies (9,26) or randomized controlled trials (15,16,27), reflecting the improved management on the prevention of CMV disease over the last years. Some patients took sequentially more than one drug, so the addition of numbers may result in >100%.…”

Section: Discussionmentioning

confidence: 45%

Impact of Antiviral Preventive Strategies on the Incidence and Outcomes of Cytomegalovirus Disease in Solid Organ Transplant Recipients

Manuel

Kralidis

Mueller

et al. 2013

American Journal of Transplantation

100

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We assessed the impact of antiviral prophylaxis and preemptive therapy on the incidence and outcomes of cytomegalovirus (CMV) disease in a nationwide prospective cohort of solid organ transplant recipients.Risk factors associated with CMV disease and graft failure-free survival were analyzed using Cox regression models. One thousand two hundred thirty-nine patients transplanted from May 2008 until March 2011 were included; 466 (38%) patients received CMV prophylaxis and 522 (42%) patients were managed preemptively. Overall incidence of CMV disease was 6.05% and was linked to CMV serostatus (Dþ/RÀ vs. Rþ, hazard ratio [HR] 5.36 [95% CI 3.14-9.14], p < 0.001). No difference in the incidence of CMV disease was observed in patients receiving antiviral prophylaxis as compared to the preemptive approach (HR 1.16 [95% CI 0.63-2.17], p ¼ 0.63). CMV disease was not associated with a lower graft failure-free survival (HR 1.27 [95% CI 0.64-2.53], p ¼ 0.50). Nevertheless, patients followed by the preemptive approach had an inferior graft failure-free survival after a median of 1.05 years of follow-up (HR 1.63 [95% CI 1.01-2.64], p ¼ 0.044). The incidence of CMV disease in this cohort was low and not influenced by the preventive strategy used. However, patients on CMV prophylaxis were more likely to be free from graft failure.

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Section: Discussionmentioning

confidence: 45%

Impact of Antiviral Preventive Strategies on the Incidence and Outcomes of Cytomegalovirus Disease in Solid Organ Transplant Recipients

Manuel

Kralidis

Mueller

et al. 2013

American Journal of Transplantation

100

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“…23 We hypothesized that transplant confers 1-year physical and mental health QOL benefi ts and sought to determine whether these benefi ts vary by sex, native disease, age, or type of transplant operation.…”

Section: Discussionmentioning

confidence: 99%

“…Trial design and enrollment criteria have been published elsewhere. 23 Inclusion in the QOL analysis required patients to have completed one or more QOL measures post lung transplant. Five randomized patients did not complete any QOL measures after lung transplantation and, therefore, were excluded ( Fig 1 depicts the study cohort).…”

Section: Qol Study Cohortmentioning

confidence: 99%

Impact of Lung Transplantation on Recipient Quality of Life

Copeland

Vock

Pieper

et al. 2013

Chest

Self Cite

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A dvanced lung disease severely impairs the quality of life (QOL) and survival of millions of individuals and lacks highly effective medical therapies. Lung transplantation has emerged as a viable treatment option for select patients with end-stage lung disease, providing 1-and 3-year survival rates of 79% and 64%, respectively. 1 In fact, lung transplantation represents the only commonly transplanted solid organ with a steady rise in international volume in recent years, with 3,272 patients undergoing lung transplantation in 2009. Although lung transplant appears to provide a short-term survival benefi t for most patients regardless

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“…A metaanalysis of 11 randomized trials (698 patients; median follow-up: 12 months, range: 3-22 months), with six randomized trials (302 patients) after kidney transplantation, demonstrated a beneficial effect of the prophylactic use of CMV immunoglobulin on total survival and prevention of Should not be used 1500 mg once a day, or 500 mg three times a day Should not be used 1000 mg once a day, or 500 mg twice a day [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Should not be used 500 mg once a day <10…”

Section: Antiviral Medications For Universal Prophylaxis and Preemptimentioning

confidence: 99%

CMV: Prevention, Diagnosis and Therapy

Kotton

2013

American Journal of Transplantation

243

218

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Cytomegalovirus (CMV) is the most common infection after organ transplantation and has a major impact on morbidity, mortality and graft survival. Optimal prevention, diagnosis and treatment of active CMV infection enhance transplant outcomes, and are the focus of this section. Methods to prevent CMV include universal prophylaxis and preemptive therapy; each has its merits, and will be compared and contrasted. Diagnostics have improved substantially in recent years, both in type and quality, allowing for more accurate and savvy treatment; advances in diagnostics include the development of an international standard, which should allow comparison of results across different methodologies, and assays for cellular immune function against CMV. Therapy primarily involves ganciclovir, now rendered more versatile by data suggesting oral therapy with valganciclovir is not inferior to intravenous therapy with ganciclovir. Treatment of resistant virus remains problematic, but is enhanced by the availability of multiple novel therapeutic agents.

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Extended Valganciclovir Prophylaxis to Prevent Cytomegalovirus After Lung Transplantation

Cited by 224 publications

References 28 publications

Impact of Antiviral Preventive Strategies on the Incidence and Outcomes of Cytomegalovirus Disease in Solid Organ Transplant Recipients

Impact of Antiviral Preventive Strategies on the Incidence and Outcomes of Cytomegalovirus Disease in Solid Organ Transplant Recipients

Impact of Lung Transplantation on Recipient Quality of Life

CMV: Prevention, Diagnosis and Therapy

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