Purpose: The optimal prophylactic strategy against CMV in lung (LTx) and heart (HTx) transplant recipients remains controversial and the proper regimen and duration of therapy unclear. We report the results of our CMV pre-emptive strategy in a consecutive cohort of TOTx recipients. Methods and Materials: 86 patients (mean age 44, range 3-67) underwent 42 LTx and 44 HTx between 05/05 and 09/08. The immunosuppressive regimen included basiliximab, FK, steroids and MMF (in selected cases) for LTx and thymoglobulin, FK, MMF and steroids for HTx. None of the patients received a prophylactic treatment for CMV. Blood viral DNA replication was assessed weekly for the first 3 months after LTx and monthly thereafter, or according to clinical indication. Patients with a DNAemia 100.000 copies or with histologically confirmed disease were treated with i.v. DHPG or with p.o.valgancyclovir. The treatment was continued until 2 nega- tive DNAemia samples were obtained. Results: After a median FU of 17 months (range 1-39), 20/88 patients (23%) received a treatment for CMV activation/disease, 41 days (median, range 15-610) after the Tx. One patient (1.1%) had CMV pneumonia. Of the 10 patients (11.6%) who had a serology mismatch, (D /R-), 3 (30%) developed a primary infection and were treated with either DHPG or valgancyclovir. One patient required long-term treatment with Foscarnet because of DHPG resistance. All patients fully recovered with negativization of the DNAemia. The 1-yr actuarial survival was 84% and 83% for LTx and HTx. We did not observe cases of drug toxicity. Conclusions: In our initial LTx and HTx experience we adopted a CMV pre-emptive approach, consisting in no prophylaxis, a strict follow-up of viral replication, and treatment guided by CMV DNAe- mia. The preliminary results showed a rate of viral activation and disease comparable with other strategies, irrespective to the different immunosuppressive regimen. Primary infections in D /R- mis- matched patients were managed without additive morbidity. All patients were able to fully recover after treatment.
A Prophylaxis-Free Strategy for the Management of CMV Infection after Thoracic Organ Transplantation (TOTx)
Bertani A;
2009-01-01
Abstract
Purpose: The optimal prophylactic strategy against CMV in lung (LTx) and heart (HTx) transplant recipients remains controversial and the proper regimen and duration of therapy unclear. We report the results of our CMV pre-emptive strategy in a consecutive cohort of TOTx recipients. Methods and Materials: 86 patients (mean age 44, range 3-67) underwent 42 LTx and 44 HTx between 05/05 and 09/08. The immunosuppressive regimen included basiliximab, FK, steroids and MMF (in selected cases) for LTx and thymoglobulin, FK, MMF and steroids for HTx. None of the patients received a prophylactic treatment for CMV. Blood viral DNA replication was assessed weekly for the first 3 months after LTx and monthly thereafter, or according to clinical indication. Patients with a DNAemia 100.000 copies or with histologically confirmed disease were treated with i.v. DHPG or with p.o.valgancyclovir. The treatment was continued until 2 nega- tive DNAemia samples were obtained. Results: After a median FU of 17 months (range 1-39), 20/88 patients (23%) received a treatment for CMV activation/disease, 41 days (median, range 15-610) after the Tx. One patient (1.1%) had CMV pneumonia. Of the 10 patients (11.6%) who had a serology mismatch, (D /R-), 3 (30%) developed a primary infection and were treated with either DHPG or valgancyclovir. One patient required long-term treatment with Foscarnet because of DHPG resistance. All patients fully recovered with negativization of the DNAemia. The 1-yr actuarial survival was 84% and 83% for LTx and HTx. We did not observe cases of drug toxicity. Conclusions: In our initial LTx and HTx experience we adopted a CMV pre-emptive approach, consisting in no prophylaxis, a strict follow-up of viral replication, and treatment guided by CMV DNAe- mia. The preliminary results showed a rate of viral activation and disease comparable with other strategies, irrespective to the different immunosuppressive regimen. Primary infections in D /R- mis- matched patients were managed without additive morbidity. All patients were able to fully recover after treatment.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
