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CMV Immunoglobulins for the Treatment of CMV Infections in Thoracic Transplant Recipients
Intravenous ganciclovir and, increasingly, oral valganciclovir are now considered the mainstay of treatment for cytomegalovirus (CMV) infection or CMV disease. Under certain circumstances, CMV immunoglobulin (CMVIG) may be an appropriate addition or, indeed, alternative. Data on monotherapy with CMV...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4764017/ https://www.ncbi.nlm.nih.gov/pubmed/26900992 http://dx.doi.org/10.1097/TP.0000000000001097 |
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author | Schulz, Uwe Solidoro, Paolo Müller, Veronika Szabo, Attila Gottlieb, Jens Wilkens, Heinrike Enseleit, Frank |
author_facet | Schulz, Uwe Solidoro, Paolo Müller, Veronika Szabo, Attila Gottlieb, Jens Wilkens, Heinrike Enseleit, Frank |
author_sort | Schulz, Uwe |
collection | PubMed |
description | Intravenous ganciclovir and, increasingly, oral valganciclovir are now considered the mainstay of treatment for cytomegalovirus (CMV) infection or CMV disease. Under certain circumstances, CMV immunoglobulin (CMVIG) may be an appropriate addition or, indeed, alternative. Data on monotherapy with CMVIG are limited, but encouraging, for example in cases of ganciclovir intolerance. In cases of recurrent CMV in thoracic transplant patients after a disease- and drug-free period, adjunctive CMVIG can be considered in patients with hypogammaglobulinemia. Antiviral-resistant CMV, which is more common among thoracic organ recipients than in other types of transplant, can be an indication for introduction of CMVIG, particularly in view of the toxicity associated with other options, such as foscarnet. Due to a lack of controlled trials, decision-making is based on clinical experience. In the absence of a robust evidence base, it seems reasonable to consider the use of CMVIG to treat CMV in adult or pediatric thoracic transplant patients with ganciclovir-resistant infection, or in serious or complicated cases. The latter can potentially include (i) treatment of severe clinical manifestations, such as pneumonitis or eye complications; (ii) patients with a positive biopsy in end organs, such as the lung or stomach; (iii) symptomatic cases with rising polymerase chain reaction values (for example, higher than 5.0 log(10)) despite antiviral treatment; (iv) CMV disease or CMV infection or risk factors, such as CMV-IgG–negative serostatus; (vi) ganciclovir intolerance; (vii) patients with hypogammaglobulinemia. |
format | Online Article Text |
id | pubmed-4764017 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-47640172016-03-01 CMV Immunoglobulins for the Treatment of CMV Infections in Thoracic Transplant Recipients Schulz, Uwe Solidoro, Paolo Müller, Veronika Szabo, Attila Gottlieb, Jens Wilkens, Heinrike Enseleit, Frank Transplantation Supplement Intravenous ganciclovir and, increasingly, oral valganciclovir are now considered the mainstay of treatment for cytomegalovirus (CMV) infection or CMV disease. Under certain circumstances, CMV immunoglobulin (CMVIG) may be an appropriate addition or, indeed, alternative. Data on monotherapy with CMVIG are limited, but encouraging, for example in cases of ganciclovir intolerance. In cases of recurrent CMV in thoracic transplant patients after a disease- and drug-free period, adjunctive CMVIG can be considered in patients with hypogammaglobulinemia. Antiviral-resistant CMV, which is more common among thoracic organ recipients than in other types of transplant, can be an indication for introduction of CMVIG, particularly in view of the toxicity associated with other options, such as foscarnet. Due to a lack of controlled trials, decision-making is based on clinical experience. In the absence of a robust evidence base, it seems reasonable to consider the use of CMVIG to treat CMV in adult or pediatric thoracic transplant patients with ganciclovir-resistant infection, or in serious or complicated cases. The latter can potentially include (i) treatment of severe clinical manifestations, such as pneumonitis or eye complications; (ii) patients with a positive biopsy in end organs, such as the lung or stomach; (iii) symptomatic cases with rising polymerase chain reaction values (for example, higher than 5.0 log(10)) despite antiviral treatment; (iv) CMV disease or CMV infection or risk factors, such as CMV-IgG–negative serostatus; (vi) ganciclovir intolerance; (vii) patients with hypogammaglobulinemia. Lippincott Williams & Wilkins 2016-03 2016-02-22 /pmc/articles/PMC4764017/ /pubmed/26900992 http://dx.doi.org/10.1097/TP.0000000000001097 Text en Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. |
spellingShingle | Supplement Schulz, Uwe Solidoro, Paolo Müller, Veronika Szabo, Attila Gottlieb, Jens Wilkens, Heinrike Enseleit, Frank CMV Immunoglobulins for the Treatment of CMV Infections in Thoracic Transplant Recipients |
title | CMV Immunoglobulins for the Treatment of CMV Infections in Thoracic Transplant Recipients |
title_full | CMV Immunoglobulins for the Treatment of CMV Infections in Thoracic Transplant Recipients |
title_fullStr | CMV Immunoglobulins for the Treatment of CMV Infections in Thoracic Transplant Recipients |
title_full_unstemmed | CMV Immunoglobulins for the Treatment of CMV Infections in Thoracic Transplant Recipients |
title_short | CMV Immunoglobulins for the Treatment of CMV Infections in Thoracic Transplant Recipients |
title_sort | cmv immunoglobulins for the treatment of cmv infections in thoracic transplant recipients |
topic | Supplement |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4764017/ https://www.ncbi.nlm.nih.gov/pubmed/26900992 http://dx.doi.org/10.1097/TP.0000000000001097 |
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