CYTOMEGALOVIRUS VIREMIA IN LUNG-TRANSPLANT RECIPIENTS RECEIVING GANCICLOVIR AND IMMUNE GLOBULIN

Background: Cytomegalovirus (CMV) disease is an important cause of org an transplant-related morbidity and mortality. During the last 5 years at our institution, prophylactic ganciclovir and hyperimmune globulin have been routinely administered to lung transplant recipients whenev er the donor or the recipient was CMV antibody-positive. We sought to assess the efficacy of prophylaxis on viremia, CMV disease, and bronch iolitis obliterans syndrome (BOS). Methods: A retrospective chart revi ew of 61 consecutive lung transplants performed between recipients bet ween January 1993 and August 1995 was performed. Fifty-six patients wh o survived at least 1 month were analyzed. Patients were considered at risk for CR-IV disease whenever pretransplant donor or recipient sero logy was positive. Results: Fourteen of the 39 patients at risk (36%) had viremia while on prophylaxis. The rate of CMV disease was 13% duri ng the first 6 months following transplantation. A donor whose CMV ser ology was positive appeared to increase the risk of BOS in a Cox regre ssion model (relative risk=2.4; 95% confidence interval=0.86-6.74; p=0 .0957). Neither age, CMV infection (viremia or a positive specimen fro m BAL), recipient's serology at the time of transplantation, or CMV di sease was associated with BOS. None of these variables was associated with mortality on Cox regression analysis or univariate analysis. Conc lusions: Administration of combination ganciclovir and hyperimmune glo bulin prophylactic therapy to lung transplant recipients at risk for C MV infection and disease is associated,vith a relatively low incidence of disease, which appears only after prophylaxis treatment with ganci clovir is completed. Ganciclovir prophylaxis does not prevent CMV vire mia; however, viremia while on prophylaxis is not predictive of diseas e.