1. A Randomized Study of Quantiferon CMV-directed Versus Fixed-duration Valganciclovir Prophylaxis to Reduce Late CMV After Lung Transplantation.
- Author
-
Westall GP, Cristiano Y, Levvey BJ, Whitford H, Paraskeva MA, Paul E, Peleg AY, and Snell GI
- Subjects
- Aged, Allografts immunology, Allografts virology, Cytomegalovirus immunology, Cytomegalovirus isolation & purification, Cytomegalovirus Infections diagnosis, Cytomegalovirus Infections epidemiology, Female, Follow-Up Studies, Humans, Incidence, Lung immunology, Lung virology, Male, Middle Aged, Time Factors, Treatment Outcome, Valganciclovir therapeutic use, Antibiotic Prophylaxis methods, Antiviral Agents therapeutic use, Cytomegalovirus Infections prevention & control, Lung Transplantation adverse effects, Monitoring, Immunologic methods
- Abstract
Background: We provide the results of the first interventional study of cytomegalovirus (CMV)-specific immune monitoring to direct the length of antiviral prophylaxis in lung transplantation (LTx)., Methods: Patients (n = 118) at risk of CMV infection were randomized 1:2 to either 5 months or variable length valganciclovir prophylaxis (5-11 mo post-LTx), as determined by the QuantiFERON (QFN)-CMV assay. Patients with a negative QFN-CMV assay (< 0.2 IU/mL) received prolonged valganciclovir prophylaxis., Results: The primary endpoint that was the incidence of CMV infection in the lung allograft within 18 months of LTx was significantly reduced in the QFN-CMV directed arm (37% versus 58%, P = 0.03). Secondary endpoints that included blood viremia, acute rejection, and chronic lung allograft dysfunction did not differ between the 2 arms. Of the 80/118 patients who ceased antiviral prophylaxis at 5 months, the incidence of viremia (> 600 copies/mL) within the blood was significantly reduced in patients with a positive QFN-CMV assay compared with those without protective immunity (13% versus 67%, P = 0.0003), as was the incidence of severe viremia (> 10 000 copies/mL) (3% versus 50%, P < 0.001). Ceasing antiviral prophylaxis at 11 months in patients with a negative assay was associated with a 25% incidence of late CMV viremia., Conclusions: Cytomegalovirus immune monitoring allows an individualized approach to CMV prophylaxis and reduces late CMV infection within the lung allograft.
- Published
- 2019
- Full Text
- View/download PDF