Prevention of cytomegalovirus infection in lung transplant recipients
- Martin Zamora, MD
Martin Zamora, MD
- Professor of Medicine, Medical Director Lung Transplant Program
- University of Colorado School of Medicine
- Section Editors
- Kieren A Marr, MD
Kieren A Marr, MD
- Section Editor — Compromised Host Infections; Fungal Infections
- Professor of Medicine and Oncology
- Johns Hopkins University School of Medicine
- Martin S Hirsch, MD
Martin S Hirsch, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Viral Infections
- Professor of Medicine
- Harvard Medical School
Cytomegalovirus (CMV), a member of the betaherpesvirus group, remains an important cause of infection, resulting in substantial morbidity and increased mortality in lung transplant recipients [1,2]. It is the second most common infection among lung transplant recipients after bacterial pneumonia [3,4].
While the development and availability of potent antiviral agents has decreased CMV-related mortality, there is a growing body of evidence that the indirect effects of CMV may be equally important or even more important than its direct effects of tissue injury and infection . CMV-induced immunosuppression may lead to infection with other opportunistic organisms. In addition, CMV infection and disease have been associated with acute and chronic rejection (bronchiolitis obliterans syndrome) in some but not all studies [5-7].
The approach to prevention of CMV infections in lung transplant recipients continues to evolve as transplant specialists gain experience using molecular diagnostic techniques and the potent oral antiviral agent valganciclovir. The prevention of CMV infection in lung transplant recipients will be discussed here. The clinical manifestations, diagnosis, and treatment of CMV infection in lung transplant recipients and infectious complications due to agents other than CMV are discussed elsewhere. (See "Clinical manifestations, diagnosis, and treatment of cytomegalovirus infection in lung transplant recipients" and "Bacterial infections following lung transplantation" and "Nontuberculous mycobacterial infections in solid organ transplant candidates and recipients" and "Tuberculosis in solid organ transplant candidates and recipients" and "Fungal infections following lung transplantation".)
Primary CMV infection is acquired through close physical contact involving direct inoculation with infected cells or body fluids. Following primary infection, CMV infection persists for life. Population studies document a gradual increase in CMV seropositivity through young adulthood. Although there is considerable variability, more than one-half of adults in the United States have serologic evidence of previous infection. (See "Epidemiology, clinical manifestations, and treatment of cytomegalovirus infection in immunocompetent adults".)
CMV infection following transplantation can be acquired in one of several ways :
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- INFECTION VERSUS DISEASE
- RISK FACTORS
- Serologic status
- DIAGNOSTIC TESTS
- Pretransplant serologic testing
- CMV DNA and antigen assays
- CMV-specific immunity
- PREVENTION OF DISEASE
- Universal prophylaxis
- - Approach to prophylaxis
- - Valganciclovir
- - Ganciclovir
- - CMV immune globulin
- Preemptive therapy
- Other approaches
- - Blood products
- - Vaccination
- SUMMARY AND RECOMMENDATIONS