scholarly journals Low-Dose Valganciclovir for CMV Prophylaxis after Lung Transplantation

2013 ◽  
Vol 2013 ◽  
pp. 1-6
Author(s):  
Hargobind S. Khurana ◽  
Alison Kole ◽  
Jeremy Falk ◽  
Sara Ghandehari ◽  
Guy Soohoo ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Lung Transplant ◽  
Low Dose ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Female Ratio ◽  
Oral Valganciclovir ◽  
Lung Transplant Recipients ◽  
Cmv Disease ◽  
Cmv Prophylaxis

Purpose. Cytomegalovirus (CMV) remains an important pathogen following solid organ transplantation (SOT). Universal prophylaxis for CMV is adopted by most centers after lung transplantation. Various combinations studied for CMV prophylaxis include intravenous and oral ganciclovirs, oral valganciclovir, and CMV immunoglobulins. We present our experience with a low-dose of oral valganciclovir for CMV prophylaxis following lung transplantation. Methods and Materials. Our center started using 450 mg of daily oral valganciclovir for CMV prophylaxis in lung transplant recipients in Jan, 2001. A retrospective chart analysis of patients who underwent lung transplantation from January 2001 to December 2006 was done. Of 46 patients, 4 were excluded as they died within 30 days of transplant from postop complications. The mean age at transplant was 64 years, mostly single lung transplants (36/6) with a male-to-female ratio of 25/17. COPD was the most common reason for transplant (65%), and the serological CMV status of donors (D) and recipients (R) was as follows: D+/R+ 28, D+/R− 5, D−/R+ 5, and D−/R− 4. Valganciclovir was given for a total of 6 months posttransplant except for D−/R+ patients who received it for 12 months. Results. Five patients (12%) developed CMV disease with an average followup of 26 months. Only 2 (4.7%) developed CMV disease within six months of completing valganciclovir prophylaxis. This incidence is not significantly different from the best-reported results of CMV prophylaxis in lung transplant recipients. The remaining 3 patients developed the disease later in their course, one as late as 32 months posttransplant. The main side effects noted include leucopenia, neutropenia, and GI disturbances. However, the number of patients who had to temporarily stop or discontinue the medication (9.5%) was significantly lower than that reported in previous studies. Conclusions. Our experience suggests that low-dose valganciclovir is an effective method of prophylaxis for CMV disease in high-risk patients. It is a simple regimen that seems to have a better side effect profile and to improve patient compliance.

scholarly journals Cytomegalovirus in Lung Transplant

2021 ◽  
Vol 05 (02) ◽  
pp. 1-1
Author(s):  
Justin P. Rosenheck ◽  
◽  
Mena M B otros ◽  
David R Nunley ◽  
◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Lung Transplant ◽  
Therapeutic Option ◽  
Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Ongoing Research ◽  
Complex Patients ◽  
Lung Transplant Recipients ◽  
New Generation

Lung transplantation is a therapeutic option for patients with advanced lung diseases. Lung transplant outcomes have improved over time with improvements in the management of these complex patients. Cytomegalovirus is a common opportunistic organism affecting all solid organ transplant recipients. Characteristics unique to lung transplantation can make this virus difficult to manage, with myriad complications including graft failure and death. Ongoing research into and understanding of cytomegalovirus has opened exciting new avenues of management. We discuss the various manifestations of CMV related pathologies in the lung transplant recipient. We discuss current mainstays of risk stratification, diagnosis, and treatment, as well as present new and evolving concepts. Current medications are highly effective at preventing and treating CMV manifestations, but may be poorly tolerated. A new generation of therapies carry the promise of efficacy, with a greater safety profile and improved tolerance of adverse effects. We discuss host-virus immune interactions, specifically how these can be utilized in clinical practice to individualize the cytomegalovirus related care of lung transplant recipients. Finally, we turn our attention to the near horizon as we continue to evolve the care of this unique population.

scholarly journals Noninvasive monitoring of infection and rejection after lung transplantation

2015 ◽  
Vol 112 (43) ◽  
pp. 13336-13341 ◽  
Author(s):  
Iwijn De Vlaminck ◽  
Lance Martin ◽  
Michael Kertesz ◽  
Kapil Patel ◽  
Mark Kowarsky ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
High Frequency ◽  
Lung Transplant ◽  
Area Under The Curve ◽  
Human Herpesvirus ◽  
Clinical Results ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Clinical Complications ◽  
Lung Transplant Recipients

The survival rate following lung transplantation is among the lowest of all solid-organ transplants, and current diagnostic tests often fail to distinguish between infection and rejection, the two primary posttransplant clinical complications. We describe a diagnostic assay that simultaneously monitors for rejection and infection in lung transplant recipients by sequencing of cell-free DNA (cfDNA) in plasma. We determined that the levels of donor-derived cfDNA directly correlate with the results of invasive tests of rejection (area under the curve 0.9). We also analyzed the nonhuman cfDNA as a hypothesis-free approach to test for infections. Cytomegalovirus is most frequently assayed clinically, and the levels of CMV-derived sequences in cfDNA are consistent with clinical results. We furthermore show that hypothesis-free monitoring for pathogens using cfDNA reveals undiagnosed cases of infection, and that certain infectious pathogens such as human herpesvirus (HHV) 6, HHV-7, and adenovirus, which are not often tested clinically, occur with high frequency in this cohort.

Antibody-Mediated Rejection Management Following Lung Transplantation

2021 ◽  
pp. 106002802110124
Author(s):  
Kristen Neuhaus ◽  
Benjamin Hohlfelder ◽  
Jessica Bollinger ◽  
Marcus Haug ◽  
Heather Torbic
Keyword(s):  
Lung Transplantation ◽  
Lung Transplant ◽  
Management Strategies ◽  
Organ Transplant ◽  
Outcome Analysis ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Antibody Mediated Rejection ◽  
Patient Admissions ◽  
Lung Transplant Recipients

Background Although antibody-mediated rejection (AMR) is described in other solid organ transplant populations, the literature describing the management following lung transplantation is limited. Objective The purpose of this study is to evaluate the management strategies of AMR in lung transplant recipients. Methods This single-center, retrospective study described the management of AMR in adult lung transplant recipients who received treatment with rabbit antithymocyte globulin, bortezomib, rituximab, intravenous immune globulin (IVIG), and/or plasmapheresis between September 2015 and June 2019. Results A total of 270 medication orders for 55 patient admissions were included in the primary outcome analysis. The most commonly used regimen consisted of IVIG, plasmapheresis, and rituximab (49.1%; n = 27), followed by IVIG and plasmapheresis alone (27.3%, n = 15). A total of 51 patients (93%) received plasmapheresis as part of their AMR treatment, with a median of 4 [3, 5] sessions per encounter; 86% of patients with positive donor-specific antibodies (DSAs) had a reduction in DSAs following AMR treatment. Overall, 23.5% of patients had noted allograft failure or need for retransplantation. A total of 10 patients died during the AMR treatment hospital admission, and an additional 11 patients died within 1 year of the initial encounter. Conclusion and Relevance This represents the largest report describing management strategies of AMR in lung transplant recipients. Although practice varied, the most commonly used regimen consisted of plasmapheresis, IVIG, and rituximab.

scholarly journals Cytomegalovirus (CMV) Disease Despite Weekly Preemptive CMV Strategy for Recipients of Solid Organ and Hematopoietic Stem Cell Transplantation

2018 ◽  
Vol 5 (5) ◽  
Author(s):  
I P Lodding ◽  
C da Cunha Bang ◽  
S S Sørensen ◽  
F Gustafsson ◽  
M Iversen ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Lung Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Hematopoietic Stem ◽  
Screening Intervals ◽  
Lung Transplant Recipients ◽  
Cmv Disease ◽  
Cmv Dnaemia

Abstract Background Transplant recipients presenting with cytomegalovirus (CMV) disease at the time of diagnosis of CMV DNAemia pose a challenge to a preemptive CMV management strategy. However, the rate and risk factors of such failure remain uncertain. Methods Solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) recipients with a first episode of CMV polymerase chain reaction (PCR) DNAemia within the first year posttransplantation were evaluated (n = 335). Patient records were reviewed for presence of CMV disease at the time of CMV DNAemia diagnosis. The distribution and prevalence of CMV disease were estimated, and the odds ratio (OR) of CMV disease was modeled using logistic regression. Results The prevalence of CMV disease increased for both SOT and HSCT with increasing diagnostic CMV PCR load and with screening intervals >14 days. The only independent risk factor in multivariate analysis was increasing CMV DNAemia load of the diagnostic CMV PCR (OR = 6.16; 95% confidence interval, 2.09–18.11). Among recipients receiving weekly screening (n = 147), 16 (10.8%) had CMV disease at the time of diagnosis of CMV DNAemia (median DNAemia load 628 IU/mL; interquartile range, 432–1274); 93.8% of these cases were HSCT and lung transplant recipients. Conclusions Despite application of weekly screening intervals, HSCT and lung transplant recipients in particular presented with CMV disease at the time of diagnosis of CMV DNAemia. Additional research to improve the management of patients at risk of presenting with CMV disease at low levels of CMV DNAemia and despite weekly screening is warranted.

A systematic review of post-transplant lymphoproliferative disorder after lung transplant.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e19046-e19046
Author(s):  
Mobeen Zaka Haider ◽  
Zarlakhta Zamani ◽  
Fnu Kiran ◽  
Hasan Mehmood Mirza ◽  
Muhammad Taqi ◽  
...  
Keyword(s):  
Lymphoproliferative Disorder ◽  
Lung Transplant ◽  
Late Onset ◽  
Adult Population ◽  
Solid Organ Transplantation ◽  
Chemotherapeutic Agents ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Post Transplant ◽  
Lung Transplant Recipients

e19046 Background: Post-transplant lymphoproliferative disorder (PTLD) is a serious complication after solid organ transplantation. This study aims to explore the association of PTLD diagnosed after lung transplant with infectious agents and immunosuppression regimen, explore types of PTLD, and their outcome. Methods: Following the PRISMA guideline, we searched the literature on PubMed, Cochrane, Embase, and clinicaltrials.gov. 1741 articles were screened and included five studies. Results: We analyzed data from five studies, n=13,643 transplant recipients with n=287 (2.10%) developed PTLD. Four studies showed that 32/63 (51%) PTLD patients were male and 31 (49%) were female. Three studies reported 53/55 (96.4%) patients were EBV positive at PTLD diagnosis. Courtwright. et al, reported that 217/224 (97%) PTLD was associated with either EBV positive donor or recipient. Four studies showed that the monomorphic B cell type 48/63 (76%) was the most common histological type of PTLD diagnosed with DLBCL the most common subtype 31/48 (64.6%). Data from 3 studies showed that the onset of PTLD following lung transplant varies with a median duration of 18.3 months (45 days to 20.2 years). Three studies showed that 26/55 (47.3%) patients had early-onset (≤ 1 yr of Tx) and 29/55 (52.7%) patients had late-onset PTLD (> 1 yr of Tx). Management of PTLD included a reduction in immunosuppression including corticosteroids, CNI, purine synthesis inhibitors, Rituximab, and chemotherapeutic agents. Three studies showed a mortality rate of 30/45 (66.7%) and 13/30 (43.3%) deaths were PTLD related. Conclusions: Our review concludes that PTLD is a serious complication, only 2% of lung transplant recipients developed PTLD. EBV seropositivity is the most factor associated with PTLD diagnosis. Monomorphic PTLD was reported as the most common type in the adult population and no association between gender and PTLD was found. The analysis shows that there is a slightly lower incidence of early (≤ 1 yr of Tx) than late-onset (> 1 yr of Tx) PTLD. Table 1 PTLD after a Lung transplant in adults - a review. [Table: see text]

scholarly journals Detrimental Association of Hypogammaglobulinemia With Chronic Lung Allograft Dysfunction and Death Is Not Mitigated by On-Demand Immunoglobulin G Replacement After Lung Transplantation

2018 ◽  
Vol 29 (1) ◽  
pp. 18-25
Author(s):  
Alicia B. Lichvar ◽  
Christopher R. Ensor ◽  
Adriana Zeevi ◽  
Matthew R. Morrell ◽  
Joseph M. Pilewski ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Immunoglobulin G ◽  
Lung Transplant ◽  
Primary Outcome ◽  
Transplant Recipients ◽  
Chronic Lung Allograft Dysfunction ◽  
On Demand ◽  
Allograft Dysfunction ◽  
Group 2 ◽  
Lung Transplant Recipients

Background: Hypogammaglobulinemia (HGG), immunoglobulin G (IgG) <700 mg/dL, is associated with infections, chronic lung allograft dysfunction, and death following lung transplantation. This study evaluates the use of on-demand intravenous IgG in lung transplant recipients with HGG. Materials and Methods: This single-center retrospective cohort study of adult lung recipients evaluated 3 groups, no, untreated (u), or treated (t) HGG at first IgG administration or a matched time posttransplant. Primary outcome was freedom from allograft dysfunction. Secondary outcomes included development of advanced dysfunction, rejection, infection burden, and mortality. Results: Recipients included 484 (no HGG: 76, uHGG: 192, tHGG: 216). Freedom from chronic allograph dysfunction was highest in the non-HGG group 2 years post-enrollment (no HGG 77.9% vs uHGG 56.4% vs tHGG 52.5%; P = .002). Freedom from advanced dysfunction was significantly different 2 years post-enrollment (no HGG 90.5% vs uHGG 84.7% vs tHGG 75.4%; P = .017). Patients without HGG and those with uHGG had less mortality at 2 years post-enrollment (no HGG 84.2% vs uHGG 81.3% vs tHGG 64.8%; P < .001). Gram-negative pneumonias occurred more often in the tHGG group ( P = .02). Conclusions: Development of chronic lung allograft dysfunction, patient survival, rejection burden, and key infectious outcomes in lung transplant recipients were still problematic in the context of on-demand IgG therapy. Prospective studies are warranted.

Antibiotic-Resistant Cytomegalovirus Infection Following Oral Valganciclovir Prophylaxis in Lung Transplant Recipients

CHEST Journal ◽  
2010 ◽  
Vol 138 (4) ◽  
pp. 546A
Author(s):  
Linda J. Stuckey ◽  
Anish Wadhwa ◽  
Daniel Kaul ◽  
Kristy Bauman ◽  
Vibha N. Lama ◽  
...  
Keyword(s):  
Cytomegalovirus Infection ◽  
Lung Transplant ◽  
Transplant Recipients ◽  
Antibiotic Resistant ◽  
Oral Valganciclovir ◽  
Lung Transplant Recipients
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