Key result
Transplantation in the valganciclovir era reduced the 10-year risk of death by an estimated 52% compared to the pre-ganciclovir era (P<0.001), independent of donor/recipient CMV serostatus.
Why the study?
Does the era of CMV prevention strategy (valganciclovir) improve 10-year survival in lung transplant recipients compared to the pre-ganciclovir era?
Cohort (n=652)
No
Does the era of CMV prevention strategy (valganciclovir) improve 10-year survival in lung transplant recipients compared to the pre-ganciclovir era?
In lung transplant recipients, modern CMV management with valganciclovir significantly improves long-term survival, neutralizing the historical risk associated with donor/recipient CMV serostatus.
CMV serostatus may influence lung transplant mortality; leaves open whether matching or prophylaxis protocols should be adjusted.
BACKGROUND: Pre-transplant cytomegalovirus (CMV) serostatus has been associated with lung transplant patient survival. We retrospectively analyzed the relationship between pre-transplant donor/recipient CMV serostatus and long-term mortality in a cohort of lung transplant recipients at our center. METHOD: Adult (Age >17 years) lung recipients transplanted between July 1985-December 2015 were analyzed. Variables included age, sex, pre-transplant donor (D)/recipient (R) serostatus [D-/R-, D-/R+, D+/R+, D+/R-], CMV infection within 2 years of transplant and transplant eras divided by changes in CMV prevention strategies: Era 1 (pre-ganciclovir, July 1985-April 1998), Era 2 (oral ganciclovir, May 1998-December 2004), Era 3 (valganciclovir, January 2005-December 2015). Survival analysis and Cox regression were performed at 10 years. RESULTS: A total of 652 lung recipients were analyzed. Twenty percent were CMV mismatched pre-transplant and 45% had CMV infection within 2 years post-transplant. Survival at 10 years appeared worse in D+ transplants (P = 0.027). D-/R- lungs did not have significantly different survival across eras (P = 0.76), but survival of D-/R+, D+/R+, D+/R- lungs improved (P < 0.001). Cox regression revealed that transplantation in the valganciclovir era reduced risk of death in lung transplants by an estimated 52% (P < 0.001) compared to transplantation in the pre-ganciclovir era after controlling for age at transplant, D/R CMV serostatus and CMV infection. Age at transplant and CMV infection were also significant predictors of mortality in lung transplants (P < 0.001 and 0.033 respectively). CONCLUSION: Our review of the impact of CMV managed differently across eras suggests in lung transplantation there is no independent influence of D/R CMV serostatus on 10-year survival.
No takes yet. Share an insight, caveat, or question.
Mabilangan et al. (2018) conducted a cohort in Lung transplant recipients (n=652). Transplantation in the valganciclovir era vs. Transplantation in the pre-ganciclovir era was evaluated on 10-year mortality (52% risk reduction, p=<0.001). Transplantation in the valganciclovir era reduced the 10-year risk of death by an estimated 52% compared to the pre-ganciclovir era (P<0.001), independent of donor/recipient CMV serostatus.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: