The Incidence of Cytomegalovirus Infection in Lung Transplant Recipients under Universal Prophylaxis with Intravenous Ganciclovir

Abstract

Objective: Determine cytomegalovirus infection incidence in lung transplantation under universal intravenous ganciclovir prophylaxis, and analyzing its effect on the lung transplant survival. Methods: 106 lung transplants performed between March/99 and Feb/04, 82 were studied, 24 were excluded due to death in the first month (n=24; 22.6%). Recipients received cyclosporine, azatioprine, and prednisone. Prophylactic ganciclovir was administered 10mg/kg/day for 3 weeks, followed by 5mg/kg/day, and 3x/week between 4th and 12th weeks. Whenever active infection was present, patients received ganciclovir 10mg/kg/day until attaining two negative antigenemia or after finishing the 21 days treatment. Peripheral blood pp65 cytomegalovirus antigenemia was used to identify active infection between weeks 3rd to 12th. It was monthly used from 4^th to 12^th month or whenever presenting clinical suspicion. Active infection was defined as any positive cell among 105 granulocytes. It was employed t Student, Ki-square and Fisher’s Exact tests, mean ± standard deviation, Kaplan Meier; it was considered significant p<0,05. Results: The incidence of cytomegalovirus infection was 68.3% (56/82). Maximum median antigenemia was 11 cells (1-1096). Median time to attain positive antigenemia was 114 days (28-343). There was no difference concerning the gender distribution (p=0.8), age (p=0.599), and type of donor (p=0.375) between patients with and without cytomegalovirus infection. Death rate during follow-up period was of 40.2% (33/82), 19.5% (16/82) in the first year without difference between groups. Conclusion: It was attained a high CMV active infection incidence among lung transplant recipients despite the intravenous ganciclovir universal prophylaxis.