Long‐term outcomes of cytomegalovirus infection and disease after lung or heart–lung transplantation with a delayed ganciclovir regimen

Thomas, Lora D.; Miller, Geraldine G.; Loyd, James E.; Dummer, J. Stephen

doi:10.1111/j.1399-0012.2009.00990.x

Cited by 18 publications

(11 citation statements)

References 30 publications

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“…Other studies have pointed out that CMV infection is one of the reasons for development of BOS [9,11-13,17,19,26] yet other studies did not find that CMV infection had any impact of the onset of BOS [27,28]. …”

Section: Discussionmentioning

confidence: 99%

Lower incidence of CMV infection and acute rejections with valganciclovir prophylaxis in lung transplant recipients

et al. 2013

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BackgroundCytomegalovirus (CMV) is the most common opportunistic infection following lung transplantation. CMV replication in the lung allograft is described as accelerating the development of bronchiolitis obliterans syndrome (BOS). Finding a strategy to prevent CMV infection is an important issue.MethodsWe performed a retrospective, single-centre study of 114 lung transplant recipients (LTRs) who underwent lung transplantation from January 2001 to December 2006. In a smaller cohort of 88 CMV seropositive (R+) LTRs, three months of valganciclovir prophylaxis (2004-2006) was compared to three months of oral ganciclovir (2001-2003) with respect to the incidence of CMV infection/disease, the severity of CMV disease, acute rejection, BOS-free 4 year survival and 4 year survival. In the whole group of 114 LTRs the impact of CMV infection on long-term survival (BOS free 4 year survival and 6 year survival) was assessed.ResultsFor the cohort of 88 CMV seropositive LTRs, the incidence of CMV infection/disease at one year was lower in the valganciclovir group compared to the ganciclovir group (24% vs. 54%, p = 0.003). There was a tendency towards reduced CMV disease, from 33% to 20% and a significant lower incidence of asymptomatic CMV infection (22% vs. 4%, p = 0.005). A lower incidence of acute rejection was observed in the valganciclovir group. However, there was no significant difference between the two groups in BOS free 4 year survival and 4 year survival.For the entire group of 114 LTRs, BOS-free 4 year survival for recipients with CMV disease was (32%, p = 0.005) and among those with asymptomatic CMV infection (36%, p = 0.061) as compared with patients without CMV infection (69%). Six year survival was lower among patients with CMV disease, (64%, p = 0.042) and asymptomatic CMV infection (55%, p = 0.018) than patients without CMV infection (84%).ConclusionsA lower incidence of CMV infection/disease and acute rejections was observed with valganciclovir (3 months) when compared to oral ganciclovir (3 months). The long-term impact of CMV infection/disease was significant for BOS-free survival and survival.

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Section: Discussionmentioning

confidence: 99%

Lower incidence of CMV infection and acute rejections with valganciclovir prophylaxis in lung transplant recipients

et al. 2013

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“…CMV has been associated with acute [39] and chronic allograft rejection, and with allograft failure [40]. Some of the transplant-specific indirect effects of CMV include chronic allograft nephropathy after renal transplantation, hepatic artery thrombosis after liver transplantation [38], coronary vasculopathy after cardiac transplantation [41], and bronchiolitis obliterans after lung transplantation [42]. Recently, CMV has been associated with the occurrence of new onset diabetes mellitus after transplant [43].…”

Section: Clinical Featuresmentioning

confidence: 99%

Cytomegalovirus Infections in Solid Organ Transplantation: A Review

2013

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Cytomegalovirus (CMV) continues to have a tremendous impact in solid organ transplantation despite remarkable advances in its diagnosis, prevention and treatment. It can affect allograft function and increase patient morbidity and mortality through a number of direct and indirect effects. Patients may develop asymptomatic viremia, CMV syndrome or tissue-invasive disease. Late-onset CMV disease continues to be a major problem in high-risk patients after completion of antiviral prophylaxis. Emerging data suggests that immunologic monitoring may be useful in predicting the risk of late onset CMV disease. There is now increasing interest in the development of an effective vaccine for prevention. Novel antiviral drugs with unique mechanisms of action and lesser toxicity are being developed. Viral load quantification is now undergoing standardization, and this will permit the generation of clinically relevant viral thresholds for the management of patients. This article provides a brief overview of the contemporary epidemiology, clinical presentation, diagnosis, prevention and treatment of CMV infection in solid organ transplant recipients.

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“…6 Typically, this imbalance may lead to the development of a negative outcome by favoring both direct CMV cytotoxic effects and by the so called indirect CMV effects, which are believed to be a consequence of the complex immunomodulatory and proinflammatory events triggered by the virus. 7,8 While both heart and lung recipients are exposed to the risk of the "indirect" effects, lung transplant recipients are particularly exposed to the "direct" cytotoxic effects of CMV: bearing endothelial, mononuclear and stromal cells, lung is a peculiar latency site of CMV, which may often combine with community acquired respiratory viruses in leading to acute and chronic graft injury [9][10][11] In this article we will revise the most recent updates regarding the therapeutic strategies for preventing CMV adverse effect and treating CMV infection in heart and lung transplantation, focusing not only on the effects and usage of pharmacologic agents, but also on the potential tools for therapy customization and specific modulation of the immune system against the virus.…”

Section: Introductionmentioning

confidence: 97%

Treatment and prevention of cytomegalovirus infection in heart and lung transplantation: an update

Potena¹,

Solidoro

Patrucco

et al. 2016

Expert Opinion on Pharmacotherapy

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Long‐term outcomes of cytomegalovirus infection and disease after lung or heart–lung transplantation with a delayed ganciclovir regimen

Cited by 18 publications

References 30 publications

Lower incidence of CMV infection and acute rejections with valganciclovir prophylaxis in lung transplant recipients

Lower incidence of CMV infection and acute rejections with valganciclovir prophylaxis in lung transplant recipients

Cytomegalovirus Infections in Solid Organ Transplantation: A Review

Treatment and prevention of cytomegalovirus infection in heart and lung transplantation: an update

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