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Extended Ganciclovir Prophylaxis in Lung Transplantation
- Source :
- The Journal of Heart and Lung Transplantation. 24:583-587
- Publication Year :
- 2005
- Publisher :
- Elsevier BV, 2005.
-
Abstract
- Background Positive cytomegaloviral status of the donor or of the recipient adversely affects survival and enhances the development of bronchiolitis obliterans syndrome (BOS) in lung transplant recipients. The role of ganciclovir prophylaxis in cytomegalovirus infection in respect to obliterative bronchiolitis or to BOS development is not known. Methods From the Papworth transplant database, we identified 146 patients who received organs from cytomegalovirus-positive donors. We classified patients into 3 groups as follows: Group 1 consisted of 42 patients who underwent transplantation between 1990 and 1992 when no prophylaxis was given; Group 2 consisted of 49 patients who underwent transplantation between 1992 and 1995 when 4 weeks of IV ganciclovir was given as prophylaxis; and Group 3 consisted of 55 patients who underwent transplantation between 1995 and 1998 when cytomegalovirus prophylaxis consisted of IV (1 week) followed by oral ganciclovir for a total of 3 months. Donor management, recipient management during and after surgery, and pharmacotherapy were uniform during the study period. We used survival and regression methods to compare these groups, adjusting for the transplantation type (single lung, double lung, or heart-lung) and for HLA typing. Results We found a significant difference among all 3 groups in numbers of cytomegaloviral disease episodes in the 1st year after transplantation. The number of rejection episodes in the 3 groups during the 1st post-transplant year gradually decreased from Group 1 to Group 3. We identified no statistically significant benefit in the time to BOS occurrence or in actuarial survival. Conclusion Extended prophylaxis with IV and oral ganciclovir practically abolishes cytomegaloviral disease and is related to a decreased incidence of rejection episodes. However, ganciclovir prophylaxis is not related to a decreased incidence or progression of BOS or survival.
- Subjects :
- Adult
Graft Rejection
Male
Pulmonary and Respiratory Medicine
Ganciclovir
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Congenital cytomegalovirus infection
Bronchiolitis obliterans
Antiviral Agents
Chemoprevention
Pharmacotherapy
Internal medicine
medicine
Humans
Lung transplantation
Bronchiolitis Obliterans
Retrospective Studies
Transplantation
business.industry
Incidence (epidemiology)
Middle Aged
medicine.disease
Surgery
Bronchiolitis
Cytomegalovirus Infections
Female
Cardiology and Cardiovascular Medicine
business
Lung Transplantation
medicine.drug
Subjects
Details
- ISSN :
- 10532498
- Volume :
- 24
- Database :
- OpenAIRE
- Journal :
- The Journal of Heart and Lung Transplantation
- Accession number :
- edsair.doi.dedup.....15b2600d454751b36cb7f9e8a5bff46a