BACKGROUND: A retrospective review of pediatric lung transplant recipients at 14 centers in North America and Europe was conducted to characterize the epidemiology and the risk factors for cytomegalovirus (CMV) and to explore the impact of preventative antiviral therapy. METHODS: Data were recorded for 1 year posttransplant. Associations between CMV and continuous and categorical risk factors were assessed using Wilcoxon rank sum and chi-square tests, respectively. Associations between time to CMV and risk factors or survival were assessed by multivariable Cox proportional hazards models. RESULTS: Within 12 months posttransplant, 172 of 577 subjects (29.8%) developed 218 CMV episodes (90 asymptomatic infection, 25 syndrome, and 103 disease). Forty-one subjects developed more than one episode of CMV. Donor or recipient CMV seropositivity was associated with increased risk of CMV episodes. Except for decreased prophylaxis in CMV D-/R- subjects, duration of prophylaxis did not vary by D/R serostatus. For CMV D+ subjects, not being on prophylaxis at the time of CMV episode increased the risk of CMV (D+/R+ hazard ratio 3.5, 95% confidence interval 1.4-8.4; D+/R- 1.9, 1.02-3.7). CMV was associated with increased mortality within the first posttransplant year among those with donor or recipient CMV seropositivity (hazard ratio 2.0: 95% confidence interval 1.1-3.6; P=0.024). CONCLUSIONS: CMV remains a serious complication after pediatric lung transplant, and the impact of prophylaxis is complex.
BACKGROUND: A retrospective review of pediatric lung transplant recipients at 14 centers in North America and Europe was conducted to characterize the epidemiology and the risk factors for cytomegalovirus (CMV) and to explore the impact of preventative antiviral therapy. METHODS: Data were recorded for 1 year posttransplant. Associations between CMV and continuous and categorical risk factors were assessed using Wilcoxon rank sum and chi-square tests, respectively. Associations between time to CMV and risk factors or survival were assessed by multivariable Cox proportional hazards models. RESULTS: Within 12 months posttransplant, 172 of 577 subjects (29.8%) developed 218 CMV episodes (90 asymptomatic infection, 25 syndrome, and 103 disease). Forty-one subjects developed more than one episode of CMV. Donor or recipient CMV seropositivity was associated with increased risk of CMV episodes. Except for decreased prophylaxis in CMV D-/R- subjects, duration of prophylaxis did not vary by D/R serostatus. For CMV D+ subjects, not being on prophylaxis at the time of CMV episode increased the risk of CMV (D+/R+ hazard ratio 3.5, 95% confidence interval 1.4-8.4; D+/R- 1.9, 1.02-3.7). CMV was associated with increased mortality within the first posttransplant year among those with donor or recipient CMV seropositivity (hazard ratio 2.0: 95% confidence interval 1.1-3.6; P=0.024). CONCLUSIONS: CMV remains a serious complication after pediatric lung transplant, and the impact of prophylaxis is complex.
Authors: Christoph Steininger; Michael Kundi; Josef Kletzmayr; Stephan W Aberle; Theresia Popow-Kraupp Journal: J Infect Dis Date: 2004-10-27 Impact factor: 5.226
Authors: S A Yousem; G J Berry; P T Cagle; D Chamberlain; A N Husain; R H Hruban; A Marchevsky; N P Ohori; J Ritter; S Stewart; H D Tazelaar Journal: J Heart Lung Transplant Date: 1996-01 Impact factor: 10.247
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Authors: R N Husni; S M Gordon; D L Longworth; A Arroliga; P C Stillwell; R K Avery; J R Maurer; A Mehta; T Kirby Journal: Clin Infect Dis Date: 1998-03 Impact factor: 9.079
Authors: N A Ettinger; T C Bailey; E P Trulock; G A Storch; D Anderson; S Raab; E L Spitznagel; C Dresler; J D Cooper Journal: Am Rev Respir Dis Date: 1993-04
Authors: Andrew Parrish; Matthew Fenchel; Gregory A Storch; Richard Buller; Sheila Mason; Nikki Williams; David Ikle; Carol Conrad; Albert Faro; Samuel Goldfarb; Don Hayes; Ernestina Melicoff-Portillo; Marc Schecter; Gary Visner; Stuart Sweet; Lara Danziger-Isakov Journal: Pediatr Transplant Date: 2017-06-21
Authors: Frederick R Adler; Paul Aurora; David H Barker; Mark L Barr; Laura S Blackwell; Otto H Bosma; Samuel Brown; D R Cox; Judy L Jensen; Geoffrey Kurland; George D Nossent; Alexandra L Quittner; Walter M Robinson; Sandy L Romero; Helen Spencer; Stuart C Sweet; Wim van der Bij; J Vermeulen; Erik A M Verschuuren; Elianne J L E Vrijlandt; William Walsh; Marlyn S Woo; Theodore G Liou Journal: Proc Am Thorac Soc Date: 2009-12