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Ganciclovir prophylaxis for cytomegalovirus infections in pulmonary allograft recipients
S R Duncan1, I L Paradis, J H Dauber
1Department of Medicine, University of Pittsburgh, Pennsylvania.
Abstract:
Cytomegalovirus (CMV) is a substantial cause of morbidity in pulmonary allograft recipients. In an attempt to decrease the prevalence of this infection, we treated 13 recipients at risk for cytomegalovirus with 3 wk of intravenous ganciclovir (5 mg/kg twice a day for 14 days, starting 5 days after the procedure, followed by 1 wk of the drug at a dose of 5 mg/kg/day). Following the ganciclovir course, patients received oral acyclovir, 800 mg three times a day for at least 2 months more. CMV infections developed in 5 recipients (38%), and none of these episodes occurred during the ganciclovir therapy. Neither of the 2 deaths in this group could be attributed to CMV. In comparison, the prevalence of CMV in the preceding cohort of 11 transplant recipients who were administered acyclovir alone was 91% (p << 0.01 by log-rank test), and there were 3 deaths due to viral infections (p = 0.08 by Fisher's exact test). Groups were similar in terms of immunosuppression and renal function during treatment, and none of the recipients developed leukopenia. We conclude that ganciclovir prophylaxis is well tolerated and appears to have considerable efficacy for prevention of CMV infections in pulmonary transplant recipients.
Insights
Ganciclovir prophylaxis significantly reduced cytomegalovirus (CMV) infections in lung transplant recipients. This treatment was well-tolerated and effective in preventing CMV disease post-transplant.
Area of Science:
- Transplantation Medicine
- Infectious Diseases
- Pulmonology
Background:
- Cytomegalovirus (CMV) is a significant cause of illness in lung transplant recipients.
- Effective strategies are needed to prevent CMV infections in this vulnerable population.
Purpose of the Study:
- To evaluate the efficacy and tolerability of ganciclovir prophylaxis for preventing CMV infections in high-risk lung allograft recipients.
Main Methods:
- A cohort of 13 lung transplant recipients received intravenous ganciclovir followed by oral acyclovir.
- Treatment duration included 3 weeks of ganciclovir and at least 2 months of oral acyclovir.
- Outcomes were compared to a historical cohort receiving acyclovir alone.
Main Results:
- CMV infections occurred in 38% of recipients receiving ganciclovir prophylaxis, compared to 91% in the acyclovir-only group (p < 0.01).
- No CMV infections occurred during the ganciclovir treatment period.
- Ganciclovir prophylaxis was well-tolerated, with no cases of leukopenia observed.
Conclusions:
- Ganciclovir prophylaxis is a well-tolerated and effective strategy for preventing CMV infections in lung transplant recipients.
- This prophylactic regimen significantly reduces the incidence of CMV disease compared to acyclovir alone.