*Purpose: Given the heightened risk of cytomegalovirus (CMV) following lung transplantation compared to other solid organ transplants, with minimal evidence based guidance specific to this patient population, the purpose of this analysis was to assess the need for high dose prophylaxis in intermediate risk recipients

*Methods: This study was a retrospective evaluation of a newly established protocol for Norton Thoracic Institute lung transplant patients at St. Joseph’s Hospital and Medical Center. There were 93 patients in the control group (old protocol). High risk patients (D+/R-) received 900 mg valganciclovir daily while all other transplant recipients (intermediate risk (D+/R+ or D-/R+) and low risk (D-/R-)) received 450 mg daily. The intervention group included 73 patients treated with the revised protocol. Both high and intermediate risk patients received 900 mg valganciclovir daily. Low risk patients received 450 mg daily. Patients were retrospectively followed for the year succeeding their transplant to assess for the primary outcome, rate of CMV (infection or disease). The patient’s electronic medical records were used to confirm protocol compliance. Secondary outcome measures assessed for adverse effects (neutropenia, renal dysfunction), acute organ rejection (confirmed with biopsy findings), and mortality.

*Results: It was expected that implementation of a new, more aggressive CMV prophylaxis protocol, extending high dose valganciclovir to intermediate risk patients, would improve patient outcomes following lung transplant. Preliminary findings demonstrate lower rates of CMV among patients treated with the revised protocol. In the intervention group, 8.2% of patients revealed a CMV positive PCR compared to 15.1% in the control. Focusing on the intermediate risk patients, where the impact of the intervention was expected to be the most substantial, rates of CMV were 19.2% for the 57 patients in the control group, and 8.5% in the 47 intervention patients (RR 0.44; P=0.13).

*Conclusions: This analysis shows trends towards benefit with the aggressive regimen. It is likely that the intervention groups were not adequately powered to achieve statistical significance. Still this research provides further information specific to prophylaxis dosing in lung transplant patients. Future analyses will aim towards assessing larger patient populations, as more data becomes available for patients treated with the new regimen.

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