Purpose: The results of a single-center experience with the management of Cytomegalovirus (CMV) after lung transplantation using a prophylaxis-free, pre-emptive strategy are retrospectively reviewed. Methods: 140 consecutive patients who received lung transplantation between June 2006 and September 2016 were included in the cohort. In all patients, CMV-DNA peripheral replication was monitored weekly for the first three months, monthly for the first year post-transplant, and every three months thereafter. No routine prophylaxis was given independently from the serological status. Immunosuppression was based on tacrolimus, MMF and low dose steroids. An antiviral treatment was initiated in patients with greater than 100,000 CMV-DNA peripheral copies/mL using i.v. gancyclovir or p.o. valgancyclovir. The antiviral treatment was continued until two consecutive negative CMV-DNA samples were obtained at weekly intervals. Patients with <100,000 CMV peripheral copies received an antiviral treatment only in case of concurrent steroid therapy for acute rejection events. The aim of the study was to assess the occurrence and morbidity of CMV disease. Results: The mean follow-up time was 3.6 years. 99 patients (70.7%) showed active replication of CMV during the follow-up period with 29 (20.7%) patients reaching the predefined threshold (>100,000 copies/mL) neces- sitating antiviral treatment. Overall, 39 patients (27.8%) received antiviral treatment for CMV. Out of 872 viral load measurements showing active CMV replication, 60 (6.9%) samples exceeded the predefined threshold warranting antiviral treatment. The median duration of the antiviral treatment was 35.0 days. CMV disease, defined as the histological evidence of the virus at an organ site, occurred in 7 patients (4.9%). No patients died for CMV as the primary cause of death. Conclusion: While most patients showed some degree of CMV replication, the vast majority of patients maintained low CMV-DNA blood levels with- out developing clinical disease. Pre-emptive therapy on patients developing >100,000 copies/mL peripheral viral replication allowed an effective control of CMV DNA-emia and maintaining a low occurrence of CMV disease. Long term follow-up of this cohort is required to assess the impact of this approach on the development of BOS.
A Prophylaxis-Free, Pre-Emptive Approach to the Management of CMV After Lung Transplantation: Single Center Results
Bertani A
;
2017-01-01
Abstract
Purpose: The results of a single-center experience with the management of Cytomegalovirus (CMV) after lung transplantation using a prophylaxis-free, pre-emptive strategy are retrospectively reviewed. Methods: 140 consecutive patients who received lung transplantation between June 2006 and September 2016 were included in the cohort. In all patients, CMV-DNA peripheral replication was monitored weekly for the first three months, monthly for the first year post-transplant, and every three months thereafter. No routine prophylaxis was given independently from the serological status. Immunosuppression was based on tacrolimus, MMF and low dose steroids. An antiviral treatment was initiated in patients with greater than 100,000 CMV-DNA peripheral copies/mL using i.v. gancyclovir or p.o. valgancyclovir. The antiviral treatment was continued until two consecutive negative CMV-DNA samples were obtained at weekly intervals. Patients with <100,000 CMV peripheral copies received an antiviral treatment only in case of concurrent steroid therapy for acute rejection events. The aim of the study was to assess the occurrence and morbidity of CMV disease. Results: The mean follow-up time was 3.6 years. 99 patients (70.7%) showed active replication of CMV during the follow-up period with 29 (20.7%) patients reaching the predefined threshold (>100,000 copies/mL) neces- sitating antiviral treatment. Overall, 39 patients (27.8%) received antiviral treatment for CMV. Out of 872 viral load measurements showing active CMV replication, 60 (6.9%) samples exceeded the predefined threshold warranting antiviral treatment. The median duration of the antiviral treatment was 35.0 days. CMV disease, defined as the histological evidence of the virus at an organ site, occurred in 7 patients (4.9%). No patients died for CMV as the primary cause of death. Conclusion: While most patients showed some degree of CMV replication, the vast majority of patients maintained low CMV-DNA blood levels with- out developing clinical disease. Pre-emptive therapy on patients developing >100,000 copies/mL peripheral viral replication allowed an effective control of CMV DNA-emia and maintaining a low occurrence of CMV disease. Long term follow-up of this cohort is required to assess the impact of this approach on the development of BOS.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
