PURPOSE: Cytomegalovirus (CMV) infection is the most common opportunistic infection in lung transplant recipients. Oral valganciclovir(Val) has excellent bioavailability and is used for both treatment and prevention of CMV infection. Herein, we describe outcomes of CMV infection(Inf) and disease(Dis) in our lung transplant population using Val.
METHODS: Retrospective evaluation of CMV at risk lung transplant recipients surviving > 30 days between March 2008&March 2010. Oral Val prophylaxis was initiated at 900 mg daily for 6 months in CMV donor(D)+ and recipient(R)- patients. D or R + patients received Val for 3 months. Doses were adjusted for renal insufficiency and leukopenia. CMV Inf was defined as BAL shedding without CMV syndrome or viremia. CMV Dis was defined as viremia or tissue invasion on biopsy.
RESULTS: 65 patients were included. Median follow up was 298 days(range 57-791). CMV at risk groups D+/R-(n=15), D+/R+(n=26), D-/R+(n=11), D-/R-(n=13). CMV Inf or Dis occurred in 17 patients. D-/R- patients had 0 events, D-/R+ 1 event, D+/R- 3 events. 50%(n=13) of the D+/R+ group had a CMV event which was statistically > D-/R- group (p=0.0057). 3 patients developed Val resistance. 1) D+/R-, IPF, POD 80, UL 97 mutation, intermittent Val due to leukopenia. 2) D+/R+, sarcoid, POD 119, UL 97, intermittent Val due to leukopenia. 3) D+/R+, CF, POD 159, UL 97&UL 54, foscarnet&cidofovir resistance. Time to Inf/Dis was shorter(median 119 vs 224 days,p=0.016)& viral load greater(54,500 copies/ml vs 14,750 copies/ml,p=0.23) in the Val resistant vs susceptible groups.
CONCLUSION: Oral Val is effective in the majority of CMV at risk lung transplant patients. CMV D+/R+ recipients are at greater risk of CMV Inf or Dis than previously described. Intermittent use of Val due to leukopenia or poor Val absorption can lead to Val resistance resulting in increased patient morbidity.
CLINICAL IMPLICATIONS: Intermittent dosing of Val or malabsorption of the medication, perhaps in the CF population can result in increased Val resistance.
DISCLOSURE: Anish Wadhwa, No Financial Disclosure Information; No Product/Research Disclosure Information