1537. Assessment of Cytomegalovirus (CMV) Infections after Lung Transplantation in the Era of Extended Antiviral Prophylaxis
Session: Poster Abstract Session: Infections and Transplantation
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • ID week poster 10.5.13.pdf (263.4 kB)
  • Background:

    CMV is the leading viral pathogen causing significant morbidity and mortality in LT recipients. Antiviral prophylaxis has been extended to reduce its impact. This study describes the epidemiology and outcome of CMV in LT recipients before and after the implementation of prolonged antiviral prophylaxis. 

    Methods:

    This study included all patients who received LT between Jan2005 and Sept2012.  Previously, CMV D+/R- patients received 6 months of valganciclovir prophylaxis while CMV R+ patients received 3 months of prophylaxis. In Jan 2007, the duration of prophylaxis was extended to 6 months for R+ and indefinitely for CMV D+ R- patients. Data before and after protocol implementation was collected.  The causes and rate of compliance to CMV prophylaxis was assessed.

    Results:

    The study cohort included 107 LT recipients. Median follow up was 985 days.  Median age at transplant was 41 (51.75-63) years.  50 recipients were male.  The most common indications for lung transplant were chronic obstructive pulmonary disease (33), idiopathic pulmonary fibrosis (32), and alpha 1 antitrypsin deficiency (9).  Median duration of CMV prophylaxis was 136 days.   37 patients were CMV D+R-. CMV infection occurred in 11 patients, disease in 6 patients, and recurrent CMV infection in 8 patients. Median time to onset of CMV infection was 378 days (262.5-658.5), and disease was 334 days (188-417).  Most of the CMV infections (13/19) and disease (6/9) were observed after the implementation of prolonged prophylaxis. No impact of CMV on mortality was observed.  58 patients developed leucopenia, leading to temporary or permanent discontinuation of CMV prophylaxis in 23 cases.

    Conclusion:

    CMV infection and disease continue to occur in LT patients despite prolonged antiviral prophylaxis. Leukopenia was common during valganciclovir use. A safe and highly effective method for CMV prophylaxis remains elusive.

    Elena Beam, MD, Internal Medicine, Mayo Clinic, Rochester, MN, Timothy Lesnick, Mayo Clinic, Rochester, MN and Raymund Razonable, MD, Department of Medicine ID, Mayo Clinic, Rochester, MN

    Disclosures:

    E. Beam, None

    T. Lesnick, None

    R. Razonable, None

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