CMV: reactivation and prematurely discontinued prophylaxis

Cytomegalovirus (CMV) prophylaxis is one of the most controversial and challenging aspect in the management of patients underwent lung transplan-tation (LuTx). The aim of this study was to report the experience in terms of incidence of early discontinuation of CMV prophylaxis and of CMV reactivation in our LuTx center. A retrospective study was conducted including all LuTx recipients from January 2009 to December 2015. Clinical and virologic data were collected in a dedicated database. Two groups of patients were identified according to CMV reactivation or not: Group A and B, respectively. From 2009 to 2015, a total of 115 LuTx were performed. Table 1 shows our results. The main reason for early discontinuation was leukopenia and anemia. Forty-height out of 115 patients were affected by at least one episode of CMV reactivation; of those, 8 were diagnosed with CMV disease. Median time of CMV reactivation was 183 (43; 642) days from LuTx. Among those who underwent reactivation, 40 (83%) prematurely discontinued prophylaxis: more specifically, CMV viremia occurred in 36% of the cases within the first 30 days from prophylaxis discontinuation, in 36% between 30 and 90 days and the rest after 90 days. Finally, CMV reactivation was associated with a higher risk of ALAD. Our data confirm the difficulty of CMV management after LuTx. We have patients who reactivated during prophylaxis and subjects who did not reacti-vate CMV even if prophylaxis was early discontinued. Such results support the urgent need of new diagnostic tools and prophylactic strategies.