Ganciclovir for Cytomegalovirus

a Call for Indefinite Prophylaxis in Lung Transplantation

Vincent G. Valentine, David Weill, Meera R. Gupta, Brad Raper, Stephanie G. LaPlace, Gisele A. Lombard, Ryan W. Bonvillain, David E. Taylor, Gundeep S. Dhillon

Research output: Contribution to journalArticle

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Abstract

Background: Universal ganciclovir (GCV) prophylaxis is a strategy aimed at reducing cytomegalovirus (CMV) infection and delaying the development of bronchiolitis obliterans syndrome (BOS). However, the optimal duration of GCV prophylaxis remains unclear. We report our experience with GCV prophylaxis administered indefinitely and its effect on CMV pneumonitis, BOS and survival after lung transplantation (LT). Methods: One hundred fifty-one patients surviving >100 days after LT were analyzed. GCV was given to 130 CMV donor- or recipient-seropositive patients. Data from 90 patients who received indefinite GCV prophylaxis (IND) and 40 patients who discontinued their GCV prophylaxis (STOP) were compared. Results: CMV pneumonitis occurred in 16%, 8%, 17% and 19% of patients in the D+R+, D-R+, D+R- and D-R- groups, respectively. In the STOP cohort, 15 of 40 patients developed CMV pneumonitis (median time 79 days) after GCV was stopped. Ten of these 15 patients developed BOS (median time 116 days) after discontinuing GCV. The risk of CMV pneumonitis in the STOP cohort was significantly higher when GCV prophylaxis was discontinued within the first year. Cumulative incidence of CMV pneumonitis in the IND and STOP groups at 5 years was 2% and 57%, respectively (p < 0.001). BOS-free survival and survival were similar across both groups. Conclusions: Indefinite GCV prophylaxis prevents CMV pneumonitis in 98% of LT recipients. Thirty-eight percent of patients discontinuing prophylaxis developed CMV pneumonitis, 50% of whom progressed to BOS within 1 year. Continuing ganciclovir prophylaxis indefinitely after lung transplantation should be considered.

Original languageEnglish (US)
Pages (from-to)875-881
Number of pages7
JournalJournal of Heart and Lung Transplantation
Volume27
Issue number8
DOIs
StatePublished - Aug 2008

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Ganciclovir
Lung Transplantation
Cytomegalovirus
Bronchiolitis Obliterans
Pneumonia
Survival
Cytomegalovirus Infections
Tissue Donors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Transplantation

Cite this

Valentine, V. G., Weill, D., Gupta, M. R., Raper, B., LaPlace, S. G., Lombard, G. A., ... Dhillon, G. S. (2008). Ganciclovir for Cytomegalovirus: a Call for Indefinite Prophylaxis in Lung Transplantation. Journal of Heart and Lung Transplantation, 27(8), 875-881. https://doi.org/10.1016/j.healun.2008.05.009

Ganciclovir for Cytomegalovirus : a Call for Indefinite Prophylaxis in Lung Transplantation. / Valentine, Vincent G.; Weill, David; Gupta, Meera R.; Raper, Brad; LaPlace, Stephanie G.; Lombard, Gisele A.; Bonvillain, Ryan W.; Taylor, David E.; Dhillon, Gundeep S.

In: Journal of Heart and Lung Transplantation, Vol. 27, No. 8, 08.2008, p. 875-881.

Research output: Contribution to journalArticle

Valentine, VG, Weill, D, Gupta, MR, Raper, B, LaPlace, SG, Lombard, GA, Bonvillain, RW, Taylor, DE & Dhillon, GS 2008, 'Ganciclovir for Cytomegalovirus: a Call for Indefinite Prophylaxis in Lung Transplantation', Journal of Heart and Lung Transplantation, vol. 27, no. 8, pp. 875-881. https://doi.org/10.1016/j.healun.2008.05.009
Valentine, Vincent G. ; Weill, David ; Gupta, Meera R. ; Raper, Brad ; LaPlace, Stephanie G. ; Lombard, Gisele A. ; Bonvillain, Ryan W. ; Taylor, David E. ; Dhillon, Gundeep S. / Ganciclovir for Cytomegalovirus : a Call for Indefinite Prophylaxis in Lung Transplantation. In: Journal of Heart and Lung Transplantation. 2008 ; Vol. 27, No. 8. pp. 875-881.
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abstract = "Background: Universal ganciclovir (GCV) prophylaxis is a strategy aimed at reducing cytomegalovirus (CMV) infection and delaying the development of bronchiolitis obliterans syndrome (BOS). However, the optimal duration of GCV prophylaxis remains unclear. We report our experience with GCV prophylaxis administered indefinitely and its effect on CMV pneumonitis, BOS and survival after lung transplantation (LT). Methods: One hundred fifty-one patients surviving >100 days after LT were analyzed. GCV was given to 130 CMV donor- or recipient-seropositive patients. Data from 90 patients who received indefinite GCV prophylaxis (IND) and 40 patients who discontinued their GCV prophylaxis (STOP) were compared. Results: CMV pneumonitis occurred in 16{\%}, 8{\%}, 17{\%} and 19{\%} of patients in the D+R+, D-R+, D+R- and D-R- groups, respectively. In the STOP cohort, 15 of 40 patients developed CMV pneumonitis (median time 79 days) after GCV was stopped. Ten of these 15 patients developed BOS (median time 116 days) after discontinuing GCV. The risk of CMV pneumonitis in the STOP cohort was significantly higher when GCV prophylaxis was discontinued within the first year. Cumulative incidence of CMV pneumonitis in the IND and STOP groups at 5 years was 2{\%} and 57{\%}, respectively (p < 0.001). BOS-free survival and survival were similar across both groups. Conclusions: Indefinite GCV prophylaxis prevents CMV pneumonitis in 98{\%} of LT recipients. Thirty-eight percent of patients discontinuing prophylaxis developed CMV pneumonitis, 50{\%} of whom progressed to BOS within 1 year. Continuing ganciclovir prophylaxis indefinitely after lung transplantation should be considered.",
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T2 - a Call for Indefinite Prophylaxis in Lung Transplantation

AU - Valentine, Vincent G.

AU - Weill, David

AU - Gupta, Meera R.

AU - Raper, Brad

AU - LaPlace, Stephanie G.

AU - Lombard, Gisele A.

AU - Bonvillain, Ryan W.

AU - Taylor, David E.

AU - Dhillon, Gundeep S.

PY - 2008/8

Y1 - 2008/8

N2 - Background: Universal ganciclovir (GCV) prophylaxis is a strategy aimed at reducing cytomegalovirus (CMV) infection and delaying the development of bronchiolitis obliterans syndrome (BOS). However, the optimal duration of GCV prophylaxis remains unclear. We report our experience with GCV prophylaxis administered indefinitely and its effect on CMV pneumonitis, BOS and survival after lung transplantation (LT). Methods: One hundred fifty-one patients surviving >100 days after LT were analyzed. GCV was given to 130 CMV donor- or recipient-seropositive patients. Data from 90 patients who received indefinite GCV prophylaxis (IND) and 40 patients who discontinued their GCV prophylaxis (STOP) were compared. Results: CMV pneumonitis occurred in 16%, 8%, 17% and 19% of patients in the D+R+, D-R+, D+R- and D-R- groups, respectively. In the STOP cohort, 15 of 40 patients developed CMV pneumonitis (median time 79 days) after GCV was stopped. Ten of these 15 patients developed BOS (median time 116 days) after discontinuing GCV. The risk of CMV pneumonitis in the STOP cohort was significantly higher when GCV prophylaxis was discontinued within the first year. Cumulative incidence of CMV pneumonitis in the IND and STOP groups at 5 years was 2% and 57%, respectively (p < 0.001). BOS-free survival and survival were similar across both groups. Conclusions: Indefinite GCV prophylaxis prevents CMV pneumonitis in 98% of LT recipients. Thirty-eight percent of patients discontinuing prophylaxis developed CMV pneumonitis, 50% of whom progressed to BOS within 1 year. Continuing ganciclovir prophylaxis indefinitely after lung transplantation should be considered.

AB - Background: Universal ganciclovir (GCV) prophylaxis is a strategy aimed at reducing cytomegalovirus (CMV) infection and delaying the development of bronchiolitis obliterans syndrome (BOS). However, the optimal duration of GCV prophylaxis remains unclear. We report our experience with GCV prophylaxis administered indefinitely and its effect on CMV pneumonitis, BOS and survival after lung transplantation (LT). Methods: One hundred fifty-one patients surviving >100 days after LT were analyzed. GCV was given to 130 CMV donor- or recipient-seropositive patients. Data from 90 patients who received indefinite GCV prophylaxis (IND) and 40 patients who discontinued their GCV prophylaxis (STOP) were compared. Results: CMV pneumonitis occurred in 16%, 8%, 17% and 19% of patients in the D+R+, D-R+, D+R- and D-R- groups, respectively. In the STOP cohort, 15 of 40 patients developed CMV pneumonitis (median time 79 days) after GCV was stopped. Ten of these 15 patients developed BOS (median time 116 days) after discontinuing GCV. The risk of CMV pneumonitis in the STOP cohort was significantly higher when GCV prophylaxis was discontinued within the first year. Cumulative incidence of CMV pneumonitis in the IND and STOP groups at 5 years was 2% and 57%, respectively (p < 0.001). BOS-free survival and survival were similar across both groups. Conclusions: Indefinite GCV prophylaxis prevents CMV pneumonitis in 98% of LT recipients. Thirty-eight percent of patients discontinuing prophylaxis developed CMV pneumonitis, 50% of whom progressed to BOS within 1 year. Continuing ganciclovir prophylaxis indefinitely after lung transplantation should be considered.

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