Cytomegalovirus infection after lung transplant: Incidence, risk factors, and management in a multicenter cohort

Cytomegalovirus (CMV) infection after lung transplant is associated with chronic rejection, but risk factors besides serology are not well-defined. Utilizing a multicenter, prospective cohort, CMV infection risk factors during and after prophylaxis were analyzed with an extended Cox model, occurring either after completion of primary prophylaxis or for a breakthrough CMV episode, while on prophylaxis. The overall cohort included 785 lung transplant recipients, of which 221 developed at least 1 CMV episode. Of the 362 recipients eligible for the off-prophylaxis analysis, 124 had a CMV episode a median of 57 days postprophylaxis. In adjusted models of off-prophylaxis, an increased risk of CMV was noted for donor CMV immunoglobulin G seropositive (D+)/recipient CMV immunoglobulin G seronegative (R-) serostatus, shorter duration of previous CMV prophylaxis, and augmented immunosuppression with either high-dose steroids or T cell-targeted therapy. In the 586 recipients eligible for the breakthrough CMV analysis, 71 had a CMV episode, and in adjusted models while on primary prophylaxis, CMV D+/R- serostatus was the only significant risk factor. Although CMV D+/R- serostatus remains an important risk factor for CMV, additional risk factors include prophylaxis duration and augmented immunosuppression, which should be considered in CMV prevention after lung transplant.