Clinical significance of post-prophylaxis cytomegalovirus infection in lung transplant recipients.

TitreClinical significance of post-prophylaxis cytomegalovirus infection in lung transplant recipients.
Publication TypeJournal Article
Year of Publication2018
AuthorsJaamei, N, Koutsokera, A, Pasquier, J, Mombelli, M, Meylan, P, Pascual, M, Aubert, J-D, Manuel, O
JournalTransplant infectious disease
Volume20
Issue4
Paginatione12893
Date Published03/2018
DOI10.1111/tid.12893
ISSN1399-3062
Mots-clésAdult, Antibiotic Prophylaxis, Antiviral Agents/therapeutic use, Cytomegalovirus Infections/epidemiology, Cytomegalovirus Infections/prevention & control, Cytomegalovirus Infections/virology, Cytomegalovirus/drug effects, Cytomegalovirus/isolation & purification, Cytomegalovirus/physiology, Female, Follow-Up Studies, Graft Rejection/epidemiology, Graft Rejection/microbiology, graft survival, Humans, Immunomodulatory effect, Lung Transplantation/adverse effects, Male, Middle Aged, prevention, Retrospective Studies, Transplant Recipients/statistics & numerical data, viral infection, Virus Replication/drug effects
Abstract

Cytomegalovirus (CMV) disease has been associated with the development of chronic lung allograft dysfunction (CLAD) after transplantation. However, the relevance of CMV replication occurring after the discontinuation of antiviral prophylaxis on the development of CLAD has not been fully established. Patients who underwent lung transplantation during 2004-2014 were included. All patients received antiviral prophylaxis for 3-6 months, followed by monitoring of CMV replication during the first year post-transplantation (preemptive therapy). Risk factors for the development of CLAD were assessed by Cox models. A linear regression model with an interaction coefficient between time and CMV infection was used to evaluate the influence of CMV infection on the evolution of FEV . Overall, 69 patients were included, 30/69 (43%) patients developed at least 1 episode of significant CMV infection, and 8/69 (11.5%) patients developed CMV disease. After a median follow-up of 3.67 years, 25/69 (36%) patients developed CLAD and 14/69 (20%) patients died. In the univariate Cox analysis, significant CMV infection (HR 1.177, P = .698), CMV disease (HR 1.001, P = .998), and duration of CMV replication (HR 1.004, P = .758) were not associated with CLAD. Only bacterial pneumonia tended to be associated with CLAD in the multivariate model (HR 2.579, P = .062). We did not observe a significant interaction between CMV replication and evolution FEV (interaction coefficient 0.006, CI 95% [-0.084 to 0.096], P = .890). In this cohort of lung transplant recipients receiving antiviral prophylaxis and monitored by preemptive therapy post-prophylaxis, CMV infection did not have impact on long-term allograft lung function.

Alternate URL

http://www.ncbi.nlm.nih.gov/pubmed/29603543?dopt=Abstract

WOS ID (UT)

000440417900004

Alternate JournalTranspl Infect Dis
Citation Key / SERVAL ID8809
Peer reviewRefereed
PubMed ID29603543

                         

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