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High incidence of clinically significant cytomegalovirus infection in CMV D+/R+ lung transplant recipients receiving 3 months of antiviral prophylaxis
Author(s) -
Kabbani Dima,
Hirji Alim,
Hernandez Cristina,
Malhi Harjot,
Mabilangan Curtis,
Chandrarathne Sanjaya,
Halloran Kieran,
Weinkauf Justin,
Kapasi Ali,
Lien Dale,
Preiksaitis Jutta,
Cervera Carlos
Publication year - 2019
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.13094
Subject(s) - medicine , cytomegalovirus , incidence (geometry) , cytomegalovirus infections , cytomegalovirus infection , lung , antiviral treatment , lung transplantation , immunology , human immunodeficiency virus (hiv) , human cytomegalovirus , herpesviridae , virus , viral disease , physics , optics , chronic hepatitis
Background Universal antiviral prophylaxis is the preferred preventive strategy for lung transplant recipients (LTRs) at risk of CMV infection. We compared the risk of CMV infection between CMV D+/R + and D‐/R + LTRs after 3 months of prophylaxis. Methods This was a retrospective review of CMV R + LTRs transplanted between 2005 and 2013. Patients dying before completing 3 months, or receiving >180 days of prophylaxis were excluded. The primary outcome was proportion of LTRs who developed CMV infection and clinically significant CMV infection defined as CMV infection leading to preemptive therapy or CMV disease. Results We analyzed 90 D+/R + and 72 D‐/R + with a median follow up of 730 days. CMV infection and disease was more common in D+/R + compared to D‐/R+ (CMV infection 66% vs 40%; P = 0.001; CMV disease 13% vs 4% P = 0.045). Fifty‐nine patients developed at least one episode of clinically significant CMV infection (41/90 [46%] D+/R + and 18/72 [25%] D‐/R + P =0.007) with recurrence occurring in 29 LTRs (49% of patients with previous CMV infection), of which 22 (76%) were CMV D+/R+. Thirty percent had side effects related to CMV therapy. Conclusion Three months prophylaxis in D+/R + LTRs was associated with high rates of clinically significant CMV infection and recurrences.