ORIGINAL ARTICLE   Open access

Panminerva Medica 2022 December;64(4):438-41

DOI: 10.23736/S0031-0808.22.04736-X

Copyright © 2022 THE AUTHORS

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language: English

Keep on tailoring CMV management in lung transplantation: 24 versus 12-month CMV hyperimmune globulins regimen effects in combined universal prophylaxis

Paolo SOLIDORO ^{1, 2}, Filippo PATRUCCO ² ✉, Carlo ALBERA ^{1, 2}, Valentina PENNAZIO ², Francesco GUERRERA ³, Massimo BOFFINI ⁴, Mauro RINALDI ⁴, Marina SAAD ¹, Rossana CAVALLO ⁵, Stefania NICOLA ⁶, Luisa BRUSSINO ^{1, 6}, Cristina COSTA ⁵

¹ Department of Medical Sciences, University of Turin, Turin, Italy; ² Division of Respiratory Diseases, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, University of Turin, Turin, Italy; ³ Division of Thoracic Surgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, University of Turin, Turin, Italy; ⁴ Division of Cardiac Surgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, University of Turin, Turin, Italy; ⁵ Division of Virology, Department of Public Health and Pediatrics, Città della Salute e della Scienza, University of Turin, Turin, Italy; ⁶ Unit of Allergy and Clinical Immunology, A. O. Ordine Mauriziano di Torino, Turin, Italy

BACKGROUND: In lung transplantation (LTx), Cytomegalovirus (CMV) management is based on prophylaxis or pre-emptive therapy. CMV hyperimmune globulins (CMV IG) added to prophylactic antiviral agents reduce CMV manifestations and acute rejection. The length of prophylaxis regimens is variable among studies with different results.
METHODS: We conduced, after demonstrating efficacy of 12 months prophylaxis on acute rejections and CMV pneumonia, a single center retrospective study comparing, during the second year after LTx, clinical effects of a long (24 months) versus short (12 months) course of combined CMV prophylaxis scheme, based on antiviral agents and CMV IG.
RESULTS: We included 120 patients, 70 received a long (24 months) and 50 a short (12 months) prophylaxis. The long prophylaxis group, at 18^th month, had a lower rate of neutrophilic alveolitis in BAL (63.6% vs. 94.4%, P=0.029). No other statistically significant differences were observed among the two groups of patients although we observed a reduction in both CMV (56.4% vs. 76.0% P=n.s.) and bacterial infections (23.7% vs. 32.0%, P=n.s.) during the 18^th month of follow-up. We did not observe differences among two groups in acute rejection rate on transbronchial lung biopsies.
CONCLUSIONS: The combined long prophylaxis course based on antiviral agents and CMV IG provides a reduction trend in CMV or bacterial infections even if not statistically significant. The significant reduction in neutrophilia in BAL compared to the cohort undergoing prophylaxis for 12 months should be carefully interpreted. An 18-month prophylaxis could be a good suggestion to be tested by other larger prospective studies.

KEY WORDS: Cytomegalovirus; Lung transplantation; Therapy