The risk, prevention, and outcome of cytomegalovirus after pediatric lung transplantation

Lara A. Danziger-Isakov, Sarah Worley, Marian G. Michaels, Susana Arrigain, Paul Aurora, Manfred Ballmann, Debra Boyer, Carol Conrad, Irmgard Eichler, Okan Elidemir, Samuel Goldfarb, George B. Mallory, Peter J. Mogayzel, Daiva Parakininkas, Melinda Solomon, Gary Visner, Stuart Sweet, Albert Faro

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50 Scopus citations

Abstract

BACKGROUND.: A retrospective review of pediatric lung transplant recipients at 14 centers in North America and Europe was conducted to characterize the epidemiology and the risk factors for cytomegalovirus (CMV) and to explore the impact of preventative antiviral therapy. METHODS.: Data were recorded for 1 year posttransplant. Associations between CMV and continuous and categorical risk factors were assessed using Wilcoxon rank sum and chi-square tests, respectively. Associations between time to CMV and risk factors or survival were assessed by multivariable Cox proportional hazards models. RESULTS.: Within 12 months posttransplant, 172 of 577 subjects (29.8%) developed 218 CMV episodes (90 asymptomatic infection, 25 syndrome, and 103 disease). Forty-one subjects developed more than one episode of CMV. Donor or recipient CMV seropositivity was associated with increased risk of CMV episodes. Except for decreased prophylaxis in CMV D+/R+ subjects, duration of prophylaxis did not vary by D/R serostatus. For CMV D+ subjects, not being on prophylaxis at the time of CMV episode increased the risk of CMV (D+/R+ hazard ratio 3.5, 95% confidence interval 1.4-8.4; D+ 1.9, 1.02-3.7). CMV was associated with increased mortality within the first posttransplant year among those with donor or recipient CMV seropositivity (hazard ratio 2.0: 95% confidence interval 1.1-3.6; P=0.024). CONCLUSIONS.: CMV remains a serious complication after pediatric lung transplant, and the impact of prophylaxis is complex.

Original languageEnglish
Pages (from-to)1541-1548
Number of pages8
JournalTransplantation
Volume87
Issue number10
DOIs
StatePublished - May 27 2009

Keywords

  • Cytomegalovirus
  • Lung transplantation
  • Pediatrics

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    Danziger-Isakov, L. A., Worley, S., Michaels, M. G., Arrigain, S., Aurora, P., Ballmann, M., Boyer, D., Conrad, C., Eichler, I., Elidemir, O., Goldfarb, S., Mallory, G. B., Mogayzel, P. J., Parakininkas, D., Solomon, M., Visner, G., Sweet, S., & Faro, A. (2009). The risk, prevention, and outcome of cytomegalovirus after pediatric lung transplantation. Transplantation, 87(10), 1541-1548. https://doi.org/10.1097/TP.0b013e3181a492e8