502: CMVIG Decreases the Risk of Cytomegalovirus Infection but Not Disease after Pediatric Lung Transplantation

A retrospective review of pediatric lung transplant recipients at fourteen sites in North America and Europe was conducted to evaluate the impact of adding cytomegalovirus immunoglobulin (CMVIG) prophylaxis to at least three weeks of intravenous ganciclovir in pediatric lung transplant recipients. Data were recorded for the first year after transplantation. Associations between time to CMV and risk factors, including CMVIG use, were assessed by multivariable Cox proportional hazards models. Of 599 subjects whose charts were reviewed, 329 received at least three weeks of ganciclovir with 62 (19%) receiving CMVIG. CMVIG was administered more frequently with CMV donor-positive/recipient-negative (D+/R−) serostatus (p<0.05). In multivariable models, subjects who did not receive CMVIG as part of their prophylaxis were three times more likely to develop CMV infection (HR 3.4; 95% CI 1.2, 9.5) independent of CMV serostatus. However, CMVIG administration was not associated with decreased risk of episodes of CMV disease. Receipt of CMVIG was not associated with decreased risks of post-transplant morbidities (acute rejection, respiratory viral infection or early bronchiolitis obliterans) or morbidity within the first year after pediatric lung transplantation. The use of CMVIG in addition to antiviral prophylaxis in pediatric lung transplantation requires further evaluation in pediatric lung transplant recipients.