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Original Article   Open accessopen access

Panminerva Medica 2022 Sep 14

DOI: 10.23736/S0031-0808.22.04736-X

Copyright © 2022 THE AUTHOR(s)

This is an open access article distributed under the terms of the CC BY-NC 4.0 license which allows users to distribute, remix, adapt and build upon the manuscript, as long as this is not done for commercial purposes, the user gives appropriate credits to the original author(s) and the source (with a link to the formal publication through the relevant DOI), provides a link to the license and indicates if changes were made.

lingua: Inglese

Keep on tailoring CMV management in lung transplantation: 24 vs 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 Medical Sciences Department, University of Turin, Turin, Italy; 2 Division of Respiratory Diseases, Cardiovascular and Thoracic Department, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy; 3 Division of Thoracic Surgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy; 4 Division of Cardiac Surgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy; 5 Division of Virology, Department of Public Health and Pediatrics, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy; 6 Allergy and Clinical Immunology Unit, AO Ordine Mauriziano Umberto I, Turin, Italy


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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 centre 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 18th 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 18th 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; CMV hyperimmune globulins; CMV prophylaxis; neutrophilic alveolitis

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