Victor Monforte1,2, Helena Sintes1,2, Cristina López-Gallo3, Maria Delgado4, Francisco Santos5, Felipe Zurbano6, Amparo Solé7, Joan Gavaldá8, Jose Maria Borro4, Javier Redel-Montero5, Jose Manuel Cifrian6, Amparo Pastor7, Antonio Román1,2, Piedad Ussetti2,3. 1. Respiratory Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. 2. Ciber Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. 3. Respiratory Department, Hospital Puerta de Hierro, Madrid, Spain. 4. Thoracic Surgery Department, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain. 5. Respiratory Department, Hospital Reina Sofía, Córdoba, Spain. 6. Respiratory Department, Hospital Marqués de Valdecilla, Santander, Spain. 7. Respiratory Department, Hospital La Fe, Valencia, Spain. 8. Infectious Disease Department, Hospital Universitari Vall d'Hebrón, Barcelona, Spain.
Abstract
BACKGROUND: The optimal length of cytomegalovirus (CMV) prophylaxis in lung transplantation according to CMV serostatus is not well established. METHODS: We have performed a prospective, observational, multicenter study to determine the incidence of CMV infection and disease in 92 CMV-seropositive lung transplant recipients (LTR), their related outcomes and risk factors, and the impact of prophylaxis length. RESULTS: At 18 months post transplantation, 37 patients (40%) developed CMV infection (23 [25%]) or disease (14 [15.2%]). Overall mortality was higher in patients with CMV disease (64.3% vs 10.2%; P<.001), but only one patient died from CMV disease. In the multivariate analysis, CMV disease was an independent death risk factor (odds ratio [OR] 18.214, 95% confidence interval [CI] 4.120-80.527; P<.001). CMV disease incidence was higher in patients with 90-day prophylaxis than in those with 180-day prophylaxis (31.3% vs 11.8%; P=.049). Prophylaxis length was an independent risk factor for CMV disease (OR 4.974, 95% CI 1.231-20.094; P=.024). Sixteen patients withdrew from prophylaxis because of adverse events. CONCLUSION: CMV infection and disease in CMV-seropositive LTR remain frequent despite current prophylaxis. CMV disease increases mortality, whereas 180-day prophylaxis reduces the incidence of CMV disease.
BACKGROUND: The optimal length of cytomegalovirus (CMV) prophylaxis in lung transplantation according to CMV serostatus is not well established. METHODS: We have performed a prospective, observational, multicenter study to determine the incidence of CMV infection and disease in 92 CMV-seropositive lung transplant recipients (LTR), their related outcomes and risk factors, and the impact of prophylaxis length. RESULTS: At 18 months post transplantation, 37 patients (40%) developed CMV infection (23 [25%]) or disease (14 [15.2%]). Overall mortality was higher in patients with CMV disease (64.3% vs 10.2%; P<.001), but only one patient died from CMV disease. In the multivariate analysis, CMV disease was an independent death risk factor (odds ratio [OR] 18.214, 95% confidence interval [CI] 4.120-80.527; P<.001). CMV disease incidence was higher in patients with 90-day prophylaxis than in those with 180-day prophylaxis (31.3% vs 11.8%; P=.049). Prophylaxis length was an independent risk factor for CMV disease (OR 4.974, 95% CI 1.231-20.094; P=.024). Sixteen patients withdrew from prophylaxis because of adverse events. CONCLUSION:CMV infection and disease in CMV-seropositive LTR remain frequent despite current prophylaxis. CMV disease increases mortality, whereas 180-day prophylaxis reduces the incidence of CMV disease.
Authors: Juliessa Florian; Guilherme Watte; Paulo José Zimermann Teixeira; Stephan Altmayer; Sadi Marcelo Schio; Letícia Beatriz Sanchez; Douglas Zaione Nascimento; Spencer Marcantonio Camargo; Fabiola Adélia Perin; José de Jesus Camargo; José Carlos Felicetti; José da Silva Moreira Journal: Sci Rep Date: 2019-06-27 Impact factor: 4.379