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Extended ganciclovir prophylaxis in lung transplantation
K G Perreas1, K McNeil, S Charman
1Transplant Unit, Papworth Hospital NHS Trust, Cambridge, United Kingdom. perreas@hotmail.com
Summary
Ganciclovir prophylaxis in lung transplant recipients significantly reduces cytomegaloviral disease and rejection episodes. However, it does not improve survival or prevent bronchiolitis obliterans syndrome (BOS).
Area of Science:
- Transplantation immunology
- Infectious disease management
Background:
- Cytomegalovirus (CMV) infection in donor or recipient negatively impacts lung transplant survival and increases bronchiolitis obliterans syndrome (BOS) risk.
- The efficacy of ganciclovir prophylaxis against CMV infection in relation to BOS development remains unclear.
Purpose of the Study:
- To evaluate the impact of varying ganciclovir prophylaxis durations on cytomegaloviral disease, rejection episodes, BOS development, and survival in lung transplant recipients.
Main Methods:
- Retrospective analysis of 146 lung transplant recipients from a single center, categorized by ganciclovir prophylaxis: none (Group 1), 4 weeks IV (Group 2), and 3 months IV/oral (Group 3).
- Comparison of outcomes including cytomegaloviral disease, rejection episodes, time to BOS, and survival, adjusting for transplant type and HLA typing.
Main Results:
- Significant reduction in cytomegaloviral disease episodes in the first post-transplant year with increasing ganciclovir prophylaxis duration.
- A decrease in rejection episodes was observed from Group 1 to Group 3.
- No statistically significant difference in time to BOS occurrence or actuarial survival was found across the groups.
Conclusions:
- Extended ganciclovir prophylaxis effectively prevents cytomegaloviral disease and reduces rejection episodes post-lung transplantation.
- Ganciclovir prophylaxis, regardless of duration, did not demonstrate a significant benefit in preventing BOS or improving long-term survival.