IMPACT OF GANCICLOVIR PROPHYLAXIS ON HEART-LUNG AND LUNG-TRANSPLANT RECIPIENTS

Background: Cytomegalovirus infection threatens pulmonary allograft su rvival and function. This retrospective study details the experience o f ganciclovir prophylaxis against cytomegalovirus infection and its se quelae. Methods: Eighty-nine lung and heart-lung transplant recipients with positive cytomegalovirus serology were analyzed. The 37 recipien ts who underwent transplantation before September 1989 received no pro phylaxis. The 52 subsequent recipients received ganciclovir prophylaxi s. Results: Thirty-six non-prophylaxed versus 42 prophylaxed patients had cytomegalovirus events with cumulative incidences of 100% and 86% (p < < 0.01), and median onsets of 37 +/- 21 versus 85 +/- 35 days, re spectively (p < < 0.01); 22 non-prophylaxed versus 27 prophylaxed pati ents had cytomegalovirus pneumonitis with cumulative incidences of 60% and 55% (p < < 0.01), and median onsets of 34 +/- 14 and 84 +/- 26 da ys, respectively (p < < 0.01). Respiratory failure caused by cytomegal ovirus pneumonitis developed in nine of the non-prophylaxed versus two of the prophylaxed patients (p < < 0.01). The significant estimated s urvival benefit in patients who received prophylaxis (p = 0.04) was no t apparent when reanalysis was performed after exclusion of patients w ith respiratory failure (p = 0.36). Ganciclovir prophylaxis produced a significant delay in the development of obliterative bronchiolitis wi th a median time to onset of 1072 +/- 280 days versus 432 + 189 days f or the non-prophylaxis cohort (p < < 0.01). Conclusions: Ganciclovir p rophyaxis (1) improves recipient survival by reducing the severity of disease and essentially eliminating respiratory failure caused by cyto megalovirus pneumonitis, (2) reduces the incidence and delays the onse t of cytomegalovirus events and pneumonitis, and (3) delays the onset of obliterative bronchiolitis.