SR Duncan, WF Grgurich, AT Iacono, GJ Burckart, SA Yousem, IL Paradis, PA Williams, BA Johnson and BP Griffith
Department of Medicine, University of Pittsburgh, Pennsylvania.

In an attempt to modify the sequelae of cytomegalovirus (CMV) infections after lung transplantation, 25 allograft recipients were randomized to either ganciclovir 5 mg/kg once a day 5 d/wk (Group G) or acyclovir 800 mg four times a day (Group A). All subjects received ganciclovir during postoperative Weeks 1 through 3, and they were then given either A or G regimens until Day 90. At termination of study enrollment, the cumulative incidence of all CMV infections (including seroconversions) was increased in Group A compared with that in Group G (75% versus 15%, p < 0.01), as was the incidence of overt CMV shedding and/or pneumonitis (50% versus 15%, p < 0.043). In comparison with those in Group G, subjects in Group A were also afflicted with an increased prevalence of obliterative bronchiolitis (OB) during the first year after transplantation (54% versus 17%, p < 0.033). Intravenous catheters for ganciclovir administration resulted in four complications among three of the subjects in Group G (23%). The short- term benefits of ganciclovir were ultimately limited, moreover, in that cumulative rates of CMV and prevalence of OB are now similar in both treatment groups after approximately 2 yr of observation. We conclude that prolonged ganciclovir prophylaxis decreases the early incidence of CMV and OB among lung transplant recipients, but these effects are of finite duration. Although CMV prevention appears to have considerable potential value in this population, definitive viral prophylaxis will require development of protracted or repeated treatment regimens, or longer-acting agents.

This article has been cited by other articles:

				L. P. Nicod Mechanisms of airway obliteration after lung transplantation. Proceedings of the ATS, July 1, 2006; 3(5): 444 - 449. [Abstract] [Full Text] [PDF]

				A. C. Kalil, J. Levitsky, E. Lyden, J. Stoner, and A. G. Freifeld Meta-Analysis: The Efficacy of Strategies To Prevent Organ Disease by Cytomegalovirus in Solid Organ Transplant Recipients Ann Intern Med, December 20, 2005; 143(12): 870 - 880. [Abstract] [Full Text] [PDF]

				R.M. Kotloff and V.N. Ahya Medical complications of lung transplantation Eur. Respir. J., February 1, 2004; 23(2): 334 - 342. [Abstract] [Full Text] [PDF]

				A. Boehler and M. Estenne Post-transplant bronchiolitis obliterans Eur. Respir. J., December 1, 2003; 22(6): 1007 - 1018. [Abstract] [Full Text] [PDF]

				L. M. Brumble, A. P. Milstone, J. E. Loyd, E. W. Ely, R. N. Pierson III, S. Gautam, and J. S. Dummer Prevention of Cytomegalovirus Infection and Disease After Lung Transplantation : Results Using a Unique Regimen Employing Delayed Ganciclovir Chest, February 1, 2002; 121(2): 407 - 414. [Abstract] [Full Text] [PDF]

				N. J. C. Snell New treatments for viral respiratory tract infections--opportunities and problems J. Antimicrob. Chemother., March 1, 2001; 47(3): 251 - 259. [Full Text] [PDF]

				Management of herpes virus infections following transplantation J. Antimicrob. Chemother., June 1, 2000; 45(6): 729 - 748. [Full Text] [PDF]

				I. G. Sia and R. Patel New Strategies for Prevention and Therapy of Cytomegalovirus Infection and Disease in Solid-Organ Transplant Recipients Clin. Microbiol. Rev., January 1, 2000; 13(1): 83 - 121. [Abstract] [Full Text] [PDF]

				M. W. Gerbase, D. Dubois, C. Rothmeier, A. Spiliopoulos, W. Wunderli, and L. P. Nicod Costs and Outcomes of Prolonged Cytomegalovirus Prophylaxis to Cover the Enhanced Immunosuppression Phase Following Lung Transplantation Chest, November 1, 1999; 116(5): 1265 - 1272. [Abstract] [Full Text] [PDF]

				S. M. Arcasoy and R. M. Kotloff Lung Transplantation N. Engl. J. Med., April 8, 1999; 340(14): 1081 - 1091. [Full Text] [PDF]

				B. Salzberger, R. A. Bowden, R. C. Hackman, C. Davis, and M. Boeckh Neutropenia in Allogeneic Marrow Transplant Recipients Receiving Ganciclovir for Prevention of Cytomegalovirus Disease: Risk Factors and Outcome Blood, September 15, 1997; 90(6): 2502 - 2508. [Abstract] [Full Text] [PDF]

				H. Reichenspurner, R. E. Girgis, R. C. Robbins, J. V. Conte, R. V. Nair, V. Valentine, G. J. Berry, R. E. Morris, J. Theodore, and B. A. Reitz Obliterative Bronchiolitis After Lung and Heart-Lung Transplantation Ann. Thorac. Surg., December 1, 1995; 60(6): 1845 - 1853. [Abstract] [Full Text]

				K. Bando, I. L. Paradis, S. Similo, H. Konishi, K. Komatsu, T. G. Zullo, S. A. Yousem, J. M. Close, A. Zeevi, R. J. Duquesnoy, et al. Obliterative bronchiolitis after lung and heart-lung transplantationAn analysis of risk factors and management J. Thorac. Cardiovasc. Surg., July 1, 1995; 110(1): 4 - 14. [Abstract] [Full Text]