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Risk factors, survival, and impact of prophylaxis length in cytomegalovirus‐seropositive lung transplant recipients: A prospective, observational, multicenter study
Author(s) -
Monforte Victor,
Sintes Helena,
LópezGallo Cristina,
Delgado Maria,
Santos Francisco,
Zurbano Felipe,
Solé Amparo,
Gavaldá Joan,
Borro Jose Maria,
RedelMontero Javier,
Cifrian Jose Manuel,
Pastor Amparo,
Román Antonio,
Ussetti Piedad
Publication year - 2017
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12694
Subject(s) - medicine , serostatus , lung transplantation , odds ratio , incidence (geometry) , cytomegalovirus , risk factor , transplantation , prospective cohort study , observational study , immunology , gastroenterology , viral disease , herpesviridae , viral load , virus , physics , optics
Background The optimal length of cytomegalovirus ( CMV ) prophylaxis in lung transplantation according to CMV serostatus is not well established. Methods We have performed a prospective, observational, multicenter study to determine the incidence of CMV infection and disease in 92 CMV ‐seropositive lung transplant recipients ( LTR ), their related outcomes and risk factors, and the impact of prophylaxis length. Results At 18 months post transplantation, 37 patients (40%) developed CMV infection (23 [25%]) or disease (14 [15.2%]). Overall mortality was higher in patients with CMV disease (64.3% vs 10.2%; P <.001), but only one patient died from CMV disease. In the multivariate analysis, CMV disease was an independent death risk factor (odds ratio [ OR ] 18.214, 95% confidence interval [ CI ] 4.120‐80.527; P <.001). CMV disease incidence was higher in patients with 90‐day prophylaxis than in those with 180‐day prophylaxis (31.3% vs 11.8%; P =.049). Prophylaxis length was an independent risk factor for CMV disease ( OR 4.974, 95% CI 1.231‐20.094; P =.024). Sixteen patients withdrew from prophylaxis because of adverse events. Conclusion CMV infection and disease in CMV ‐seropositive LTR remain frequent despite current prophylaxis. CMV disease increases mortality, whereas 180‐day prophylaxis reduces the incidence of CMV disease.