Long‐Term Outcomes Among Lung Transplant Recipients With High‐Risk Cytomegalovirus Mismatch Managed With a Multimodality Regimen
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Wiley
2025
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| author | Natasha Banga Rohan Kanade Anishka Kappalayil Irina Timofte Adrian Lawrence Srinivas Bollineni Vaidehi Kaza Fernando Torres |
| author_facet | Natasha Banga Rohan Kanade Anishka Kappalayil Irina Timofte Adrian Lawrence Srinivas Bollineni Vaidehi Kaza Fernando Torres Natasha Banga Rohan Kanade Anishka Kappalayil Irina Timofte Adrian Lawrence Srinivas Bollineni Vaidehi Kaza Fernando Torres |
| collection | Wiley Open Access |
| contents | Long‐Term Outcomes Among Lung Transplant Recipients With High‐Risk Cytomegalovirus Mismatch Managed With a Multimodality Regimen Natasha Banga Rohan Kanade Anishka Kappalayil Irina Timofte Adrian Lawrence Srinivas Bollineni Vaidehi Kaza Fernando Torres Clinical Transplantation ABSTRACTBackgroundLung transplant (LT) recipients with high‐risk cytomegalovirus (CMV) mismatch donors (donor seropositive, recipient seronegative) have worse early and late outcomes. We sought to describe the outcomes among high‐risk mismatch patients managed using proactive monitoring and multimodality prophylaxis and management protocol.MethodsWe included patients with single or bilateral lung transplants between January 2012 and December 2016 (n = 324). The patients were classified into two groups: high‐risk CMV mismatch (R−/D+): n = 83 (25.6%) and non‐high‐risk CMV mismatch (n = 241). Post‐LT follow‐up period ranged from 8 to 12 years. Post‐transplant survival was analyzed as the primary outcome variable.ResultsThere was no difference in LT recipients' baseline and post‐transplant characteristics with and without CMV‐mismatch donors. The mismatch group experienced a significantly higher frequency and burden of CMV viremia (p < 0.001) and resistant viremia (p < 0.001). Regardless, the two groups had similar long‐term outcomes with no statistically significant difference in CLAD‐free survival at 3 years or overall post‐transplant survival. On Cox proportional hazard analysis, transplant indication was the only independent predictor of post‐transplant survival (p = 0.004).ConclusionsA proactive multimodality CMV management protocol consisting of antiviral agents (ganciclovir/valganciclovir) and immune augmentation with CMV immune globulin may improve outcomes among high‐risk CMV mismatch LT recipients. 10.1111/ctr.70219 http://creativecommons.org/licenses/by-nc/4.0/ |
| doi_str_mv | 10.1111/ctr.70219 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_ctr_70219 |
| institution | Wiley Open Access |
| license_str_mv | http://creativecommons.org/licenses/by-nc/4.0/ |
| publishDate | 2025 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Long‐Term Outcomes Among Lung Transplant Recipients With High‐Risk Cytomegalovirus Mismatch Managed With a Multimodality Regimen Natasha Banga Rohan Kanade Anishka Kappalayil Irina Timofte Adrian Lawrence Srinivas Bollineni Vaidehi Kaza Fernando Torres Clinical Transplantation Long‐Term Outcomes Among Lung Transplant Recipients With High‐Risk Cytomegalovirus Mismatch Managed With a Multimodality Regimen Natasha Banga Rohan Kanade Anishka Kappalayil Irina Timofte Adrian Lawrence Srinivas Bollineni Vaidehi Kaza Fernando Torres Clinical Transplantation ABSTRACTBackgroundLung transplant (LT) recipients with high‐risk cytomegalovirus (CMV) mismatch donors (donor seropositive, recipient seronegative) have worse early and late outcomes. We sought to describe the outcomes among high‐risk mismatch patients managed using proactive monitoring and multimodality prophylaxis and management protocol.MethodsWe included patients with single or bilateral lung transplants between January 2012 and December 2016 (n = 324). The patients were classified into two groups: high‐risk CMV mismatch (R−/D+): n = 83 (25.6%) and non‐high‐risk CMV mismatch (n = 241). Post‐LT follow‐up period ranged from 8 to 12 years. Post‐transplant survival was analyzed as the primary outcome variable.ResultsThere was no difference in LT recipients' baseline and post‐transplant characteristics with and without CMV‐mismatch donors. The mismatch group experienced a significantly higher frequency and burden of CMV viremia (p < 0.001) and resistant viremia (p < 0.001). Regardless, the two groups had similar long‐term outcomes with no statistically significant difference in CLAD‐free survival at 3 years or overall post‐transplant survival. On Cox proportional hazard analysis, transplant indication was the only independent predictor of post‐transplant survival (p = 0.004).ConclusionsA proactive multimodality CMV management protocol consisting of antiviral agents (ganciclovir/valganciclovir) and immune augmentation with CMV immune globulin may improve outcomes among high‐risk CMV mismatch LT recipients. 10.1111/ctr.70219 http://creativecommons.org/licenses/by-nc/4.0/ |
| title | Long‐Term Outcomes Among Lung Transplant Recipients With High‐Risk Cytomegalovirus Mismatch Managed With a Multimodality Regimen |
| topic | Clinical Transplantation |
| url | https://onlinelibrary.wiley.com/doi/10.1111/ctr.70219 |