PROPHYLAXIS AND MANAGEMENT OF CYTOMEGALOVIRUS PNEUMONITIS AFTER LUNG TRANSPLANTATION - A REVIEW OF EXPERIENCE IN ONE-CENTER

Our experience was reviewed to assess the incidence and severity of cy tomegalovirus disease after lung transplantation. Between 1987 and 199 2, 74 lung transplantations were performed. Donor and recipient sera w ere tested for cytomegalovirus immunoglobulin G at the time of transpl antation; in the event that an organ from a positive donor was transpl anted into a negative recipient, a course of hyperimmune globulin was given. Significant pyrexial episodes were thoroughly investigated by b ronchioalveolar lavage and transbronchial biopsy, where appropriate. A ntiviral therapy was given only if progressive pneumonitis or a diseas e affecting more than one organ system was present. Fifty-nine patient s survived more than 28 days after transplantation; organs from antibo dy-positive donors were transplanted into nine sero-negative recipient s. Cytomegalovirus pneumonitis was diagnosed histologically in five of these patients; four were treated with ganciclovir therapy, and two u nderwent reventilation. All but one patient survived; the role of cyto megalovirus in the outcome of this patient remains uncertain. No recur rent infections have been seen. Of these nine patients, all but one wa s seroconverted to immunoglobulin M. Although frequently found to be e xcreting virus, of the 35 patients who were antibody positive before t ransplantation, pneumonitis was diagnosed histologically in five patie nts, two of whom required both treatment and reventilation and who sub sequently died despite early treatment. Our findings, compared with hi storical data, suggest that the prophylactic use of high-titer immunog lobulin may reduce the incidence of pneumonitis in the mismatch group. The role of specific prophylaxis in patients who were antibody positi ve before transplantation requires further evaluation.