Clinical transplantation proceedingsUse of combination cytomegalovirus immune globulin plus ganciclovir for prophylaxis in CMV-seronegative liver transplant recipients of a CMV-seropositive donor organ: a multicenter, open-label study
Section snippets
Study population
Eligible patients included children and adults who underwent liver transplantation at the participating centers: New England Medical Center, Children’s Hospital, and Massachusetts General Hospital, Boston, Massachusetts; Cleveland Clinic Foundation, Cleveland, Ohio; and Emory University Hospital, Atlanta, Georgia. The study protocol was approved by the human investigation review committee of each institution.
Microbiologic and serologic studies, follow-up, and case definitions of
Results
There were 44 orthotopic liver transplant recipients presumed to be CMV-seronegative who received a CMV-seropositive donor organ and who were enrolled in the study from September 1993 to 1996. Five were dropped from analysis because the final CMV serologic status of the donor was negative, leaving 39 evaluable D+/R− patients. Of the 39 enrollees, 26% developed CMV disease, 15% developed tissue-invasive CMV disease, and 5% developed severe CMV-associated disease. The 1-year survival was 92% and
Discussion
We have shown that the use of intravenous ganciclovir for 2 weeks plus cytomegalovirus immune globulin over 4 months along with preemptive intravenous ganciclovir during treatment for rejection significantly reduces tissue-invasive CMV disease and severe CMV-associated disease in high-risk orthotopic liver transplant recipients who are CMV-seronegative and receive a CMV-seropositive donor organ. This difference persisted after controlling for renal function at transplant, volume of blood, and
Acknowledgements
This study was supported in part by an unrestricted grant from MedImmune, Inc. (Gaithersburg, Md, USA). The authors wish to thank Mrs Roselia Martinez for her assistance in putting the manuscript together. The authors want to acknowledge the assistance of Judy Brakeman, RN, Jeanne Grindlinger, RN. Monique Crowley, RN, and Maureen Doran, R.N.
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Prevention and therapy of viral infections in patients with solid organ transplantation
2021, Enfermedades Infecciosas y Microbiologia ClinicaCitation Excerpt :Early post-transplant hypogammaglobulinemia (HGG), defined by a serum IgG level < 600 mg/dL at day 7, has been described as a risk factor for CMV disease in LuT40 and HT recipients.41 Intravenous CMV-specific hyperimmune globulin (CMV-HIG) or polyclonal intravenous immunoglobulins (IVIGs) associated with antiviral prophylaxis has been shown to reduce the incidence of CMV disease after LT,42 LuT43–45 and HT.44 Thus, some centers that perform LuT and HT have incorporated this adjunctive treatment to their clinical practice.33
Management strategies for cytomegalovirus infection and disease in solid organ transplant recipients
2013, Infectious Disease Clinics of North AmericaCitation Excerpt :However, this practice was associated with significant myelotoxicity, which required the temporary or permanent discontinuation of valganciclovir prophylaxis.88 In selected patient populations (heart and lung recipients, and intestinal transplant recipients), unselected or CMV-specific Ig preparations have occasionally been used as an adjunct in combination with antiviral drugs.89,90 A pooled analysis of previous studies suggest that the addition of Ig preparations to antiviral prophylaxis may reduce severe CMV disease and mortality,91 but this finding has been debated.92
Human monoclonal antibody MBL-HCV1 delays HCV viral rebound following liver transplantation: A randomized controlled study
2013, American Journal of TransplantationCitation Excerpt :Findings from single source HCV outbreaks show a strong neutralizing antibody response correlates with viral clearance (11,12). In the liver transplantation setting, initiation of hyperimmune globulin therapy in the peri-transplantation period, alone or in combination with anti-viral small molecules, can prevent cytomegalovirus and HBV disease (13–15). For HCV, the exclusively cytoplasmic life cycle and limited cellular tropism make eradication after LT theoretically possible.
Passive immunization
2011, Primary Care - Clinics in Office PracticeCitation Excerpt :Several studies have been performed giving pregnant mothers with primary CMV disease CMV immune globulin, either intraperitoneally, within the amniotic sac or umbilical cord, or intravenously.35,36 In 1 study only 1 mother of 31 in the study gave birth to a child with CMV infection, versus 7 of 14 in the control group.31 While not recommended for routine pregnancies, this may offer some benefit in certain situations.
Cytomegalovirus in solid organ transplant recipients
2009, American Journal of TransplantationCytomegalovirus Immunoglobulin Decreases the Risk of Cytomegalovirus Infection but not Disease After Pediatric Lung Transplantation
2009, Journal of Heart and Lung TransplantationCitation Excerpt :Alternatively, some reports have demonstrated that administration of CMVIG resulted in decreased episodes of tissue-invasive CMV disease in adult liver transplant recipients.10 Additional studies in liver transplant recipients from the same group reported that the addition of ganciclovir to CMVIG is superior to CMVIG alone and is cost-effective.26,27 In adult heart transplant patients, CMVIG alone can decrease the risk of CMV disease28; further, the prophylactic administration of CMVIG with ganciclovir significantly reduced rates of CMV disease compared with rates in those who received ganciclovir alone.9,20