Special considerations regarding CMV in lung transplantation

Lung transplant recipients, more than other organ transplant recipients, are at particular risk for cytomegalovirus (CMV) infection and disease. A major factor in improving management of the lung transplant patient is the ability to prevent or minimize CMV disease, which itself is a major risk factor for opportunistic fungal infections and obliterative bronchiolitis. Strategies being evaluated to improve CMV prophylaxis and consequently graft and patient survival include longer-than-standard courses of prophylactic IV ganciclovir, sequential IV/oral therapy, addition of CMV IG, examining the impact of newer immunosuppressive agents, the role of hypogammaglobulinemia, and potential investigational studies with newer antiviral agents.