Thorac Cardiovasc Surg 2007; 55 - V_66
DOI: 10.1055/s-2007-967346

Prophylactic vs. preemptive CMV-therapy after lung transplantation (LTX)

M Irlbeck 1, M Fechner 1, R Baumgartner 2, J Behr 2, T Strauss 3, R Hatz 3, P Überfuhr 4, E Kreuzer 4 L Frey 1, Munich Lung Transplant Group
  • 1Ludwig-Maximilians-Universität, Klinik für Anaesthesiologie, München, Germany
  • 2Ludwig-Maximilians-Universität, Medizinische Klinik I, Pneumologie, München, Germany
  • 3Ludwig-Maximilians-Universität, Chirurgische Klinik, München, Germany
  • 4Ludwig-Maximilians-Universität, Herzchirurgische Klinik, München, Germany

Aims: For the prevention of CMV associated morbidity after LTX, the concept of prophylactic virostatic therapy stands in contrast to the concept of preemptive therapy. Studies comparing the effectiveness of both concepts after LTX are lacking.

Methods: In a retrospective analysis, the effects of preemptive CMV therapy were compared to prophylactic therapy in 131 patients after LTX between January 2000 and March 2005. All patients were screened weekly by CMV-PCR in the serum. Until June 2002, a prophylactic CMV regime with ganciclovir was carried out for patients at risk and without contraindications for at least 28 days (n=42). After June 2002, in the sense of a preemptive regime, ganciclovir therapy was initiated only in case of a positive PCR. Patients were studied with regard to episodes of CMV infection, reactivation and disease for a period of 12 months after transplantation.

Results: 30 (71.4%) patients in the prophylactic and 30 (45.5%) patients in the preemptive group were treated with ganciclovir at one point of time (p=0.010). During the study, CMV PCR was positive at least once for 13 (31%) patients of the prophylactic and 30 (45%) patients of the preemptive group (n.s.). The median time span from transplantation was significantly longer in the prophylactic group (121 days) than in the preemptive group (43 days; p=0.041). No significant difference was found concerning the incidence of CMV (organ-) disease (n=8 (19.0%) in the prophylactic, n=9 (13.6%) in the preemptive group).

Conclusions: Preemptive therapy is equally effective as prophylactic therapy with regard to the prevention of CMV infection or disease and allows significant reduction of virostatic therapy prone to side effects.