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Oral Valganciclovir versus Intravenous Ganciclovir for CMV Prophylaxis After Lung Transplantation FREE TO VIEW

Fletcher N. Pierce, MD; Steven D. Nathan, MD; Scott D. Barnett, PhD; Mary E. Schmidt, MD; Shahzad Ahmad, MD; Nelson A. Burton, MD
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Inova Transplant Center, Falls Church, VA


Chest


Chest. 2003;124(4_MeetingAbstracts):100S. doi:10.1378/chest.124.4_MeetingAbstracts.100S-b
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Abstract

INTRODUCTION:  CMV infection is a major cause of morbidity and mortality in transplant recipients. For this reason patients are often prophylaxed against CMV infections in the postoperative period. The advent of new oral medications has broadened the options for prophylaxis, but there is a paucity of data attesting to their efficacy. We analyzed our data of lung transplant patients before and after the availability of oral valganciclovir.

METHODS:  We retrospectively reviewed 46 consecutive charts of lung transplant patients. The latest 23 patients (group A) were treated with IV ganciclovir only while intubated and PO valganciclovir once extubated (valganciclovir 900 mg bid x 1 month, then 900 mg qd x 5 months). We compared these patients to the previous 23 patients (group B) who were treated with IV ganciclovir for 4 weeks and then switched to oral medications (either ganciclovir or valganciclovir) for an additional 5 months. We compared the groups for CMV antigenemia (CMV Ag) positivity, CMV cultures from bronchoalveolar lavage (BAL) and clinical CMV infections. The immunosuppressive regimen for all patients consisted of tacrolimus, azathioprine and prednisone. No patient received cytolytic therapy.

RESULTS:  The median duration of IV ganciclovir in group A was 2.6 days (range 0–9 days). 1/23 patients in group A developed a positive CMV Ag at 5 months post-transplant, while 6/23 patient in group B developed a positive CMV AG at 6,10,11,13 and 15 months, respectively. CMV culture in BAL was positive in 1/23 patients in group A versus 2/23 in group B. There was no episode of clinical CMV infection in group A, whereas 2 episodes were seen in group B.

CONCLUSION:  No statistical differences were seen between oral valganciclovir and IV ganciclovir with regards to clinical infections.

CLINICAL IMPLICATIONS:  Oral valganciclovir is as effective as IV ganciclovir for CMV prophylaxis in lung transplant recipients.

DISCLOSURE:  F.N. Pierce, None.

Tuesday, October 28, 2003

10:30 AM - 12:00 PM


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