Cytomegalovirus immunoglobulin decreases the risk of cytomegalovirus infection but not disease after pediatric lung transplantation. J Heart Lung Transplant 2009 Oct;28(10):1050-6
Date
09/29/2009Pubmed ID
19782286Pubmed Central ID
PMC2771443DOI
10.1016/j.healun.2009.04.032Scopus ID
2-s2.0-70349400518 (requires institutional sign-in at Scopus site) 31 CitationsAbstract
BACKGROUND: Cytomegalovirus (CMV) has been associated with morbidity, including chronic allograft rejection, in transplant recipients. Data from adult centers suggests that CMV hyperimmune globulin (CMVIG) and ganciclovir together are superior in preventing CMV viremia than ganciclovir alone.
METHODS: A retrospective review of pediatric lung transplant recipients at 14 sites in North America and Europe was conducted to evaluate the effect of adding cytomegalovirus immunoglobulin (CMVIG) prophylaxis to at least 3 weeks of intravenous ganciclovir therapy in pediatric lung transplant recipients. Data were recorded for the first year after transplantation. Associations between time to CMV and risk factors, including CMVIG use, were assessed by multivariable Cox proportional hazards models.
RESULTS: Of 599 patients whose records were reviewed, 329 received at least 3 weeks of ganciclovir, with 62 (19%) receiving CMVIG. CMVIG was administered more frequently with CMV donor-positive/recipient-negative serostatus (p < 0.05). In multivariable models, patients who did not receive CMVIG as part of their prophylaxis were 3 times more likely to develop CMV infection (hazard ratio, 3.4; 95% confidence interval, 1.2-9.5) independent of CMV serostatus. However, CMVIG administration was not associated with decreased risk of episodes of CMV disease. Receipt of CMVIG was not associated with decreased risks of post-transplant morbidities (acute rejection, respiratory viral infection or early bronchiolitis obliterans) or morbidity within the first year after pediatric lung transplantation.
CONCLUSION: The use of CMVIG in addition to antiviral prophylaxis in pediatric lung transplantation requires further evaluation.
Author List
Ranganathan K, Worley S, Michaels MG, Arrigan S, Aurora P, Ballmann M, Boyer D, Conrad C, Eichler I, Elidemir O, Goldfarb S, Mallory GB Jr, Mogayzel PJ, Parakininkas D, Solomon M, Visner G, Sweet SC, Faro A, Danziger-Isakov LAuthor
Daiva E. Parakininkas MD Associate Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAntiviral Agents
Bronchiolitis Obliterans
Child
Child, Preschool
Cytomegalovirus Infections
Dose-Response Relationship, Drug
Drug Therapy, Combination
Female
Ganciclovir
Graft Rejection
Humans
Immunoglobulins
Immunoglobulins, Intravenous
Incidence
Infant
Lung Transplantation
Male
Proportional Hazards Models
Retrospective Studies
Risk Factors
Viremia
Young Adult