Prophylaxis and management of cytomegalovirus pneumonitis after lung transplantation: a review of experience in one center.

Our experience was reviewed to assess the incidence and severity of cytomegalovirus disease after lung transplantation. Between 1987 and 1992, 74 lung transplantations were performed. Donor and recipient sera were tested for cytomegalovirus immunoglobulin G at the time of transplantation; in the event that an organ from a positive donor was transplanted into a negative recipient, a course of hyperimmune globulin was given. Significant pyrexial episodes were thoroughly investigated by bronchioalveolar lavage and transbronchial biopsy, where appropriate. Antiviral therapy was given only if progressive pneumonitis or a disease affecting more than one organ system was present. Fifty-nine patients survived more than 28 days after transplantation; organs from antibody-positive donors were transplanted into nine sero-negative recipients. Cytomegalovirus pneumonitis was diagnosed histologically in five of these patients; four were treated with ganciclovir therapy, and two underwent reventilation. All but one patient survived; the role of cytomegalovirus in the outcome of this patient remains uncertain. No recurrent infections have been seen. Of these nine patients, all but one was seroconverted to immunoglobulin M. Although frequently found to be excreting virus, of the 35 patients who were antibody positive before transplantation, pneumonitis was diagnosed histologically in five patients, two of whom required both treatment and reventilation and who subsequently died despite early treatment. Our findings, compared with historical data, suggest that the prophylactic use of high-titer immunoglobulin may reduce the incidence of pneumonitis in the mismatch group. The role of specific prophylaxis in patients who were antibody positive before transplantation requires further evaluation.