Tailored combined cytomegalovirus management in lung transplantation: a retrospective analysis. (September 2019)

• Record Type: Journal Article
• Authors: Solidoro, Paolo; Patrucco, Filippo; Libertucci, Daniela; Verri, Giulia; Sidoti, Francesca; Curtoni, Antonio; Boffini, Massimo; Simonato, Erika; Rinaldi, Mauro; Cavallo, Rossana; Costa, Cristina
• Is Part Of: Therapeutic advances in respiratory disease. Volume 13(2019)
• Publication Date: 2019-09
• Subjects: CMV ELISPOT -- CMV pulmonary infection -- CMV viremia -- cytomegalovirus -- lung transplant -- prophylaxis; Respiratory organs -- Diseases -- Periodicals; Respiratory agents -- Periodicals; Pulmonary pharmacology -- Periodicals; Respiratory Tract Diseases -- Periodicals; Respiratory System Agents -- therapeutic use -- Periodicals; Respiratory Tract Diseases -- drug therapy -- Periodicals; Lung Diseases -- drug therapy -- Periodicals; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Agents respiratoires -- Périodiques; Pharmacologie pulmonaire -- Périodiques; 616.2005
• DOI: 10.1177/1753466619878555
• Languages: English
• ISSNs: 1753-4658

Abstract

Background: There is no univocal prophylactic regimen to prevent cytomegalovirus (CMV) infection/disease in lung transplantation (LT) recipients. The aim of this study is to evaluate short-term clinical outcomes of a tailored combined CMV management approach. Methods: After 1-year follow up, 43 LT patients receiving combined CMV prophylaxis with antiviral agents and CMV-specific IgG were evaluated in a retrospective observational study. Systemic and lung viral infections were investigated by molecular methods on a total of 1134 whole blood and 167 bronchoalveolar lavage (BAL) and biopsy specimens. CMV immunity was assessed by ELISPOT assay. Clinical and therapeutic data were also evaluated. Results: We found 2/167 cases of CMV pneumonia (1.2%), both in the donor-positive/recipient-positive (D + /R + ) population, and 51/167 cases of CMV pulmonary infection (BAL positivity 30.5%). However, only 32/167 patients (19.1%) were treated due to their weak immunological response at CMV ELISPOT assay. Viremia ⩾100, 000 copies/mL occurred in 33/1134 specimens (2.9%). Regarding CMV-serological matching (D/R), the D + /R – population had more CMV viremia episodes ( p < 0.05) and fewer viremia-free days ( p < 0.001). Conclusions: Compared to previous findings, our study shows a lower incidence of CMV pneumonia and viremia despite the presence of a substantial CMV load. In addition, our findings further confirm the D + /R – group to be a high-risk population for CMV viremia. Overall, a good immunological response seems to protect patients from CMV viremia and pneumonia but not from CMV alveolar replication. The reviews of this paper are available via the supplemental material section.