What is the optimal duration of antiviral prophylaxis for preventing cytomegalovirus infection in high risk lung transplant recipients?

Transplantation is a life-saving procedure for patients with end-stage organ disease, but requires immunosuppressive medications to prevent rejection. This increases risk and severity of infections that don’t normally affect healthy individuals, which contribute significantly to morbidity and mortality. One of the most common and significant of these is cytomegalovirus (CMV) which causes clinical disease and indirect effects such as rejection, secondary infections and decreased survival. Lung transplant recipients who are not previously infected with CMV but acquire it from their transplant donor (donor positive, recipient negative or D+/R-) are the highest risk. A highly effective antiviral called valganciclovir is available, but has a risk of side effects including neutropenia. While valganciclovir prophylaxis is effective at preventing CMV infection, there is a wide variation in duration used at different centres worldwide. This clinical research project aims to understand the optimal CMV prevention strategies in D+/R- lung transplant recipients, to improve our understanding of how best to use valganciclovir prophylaxis to prevent this serious infectious complication of transplantation. It will involve performing a systematic review and meta-analysis of existing published studies performed in this high-risk subset of patients, to determine the optimal duration of prophylaxis. It will involve statistical analyses and other clinical research methodologies but no laboratory work. Previous experience using R is desirable but not essential. It will set the groundwork for future clinical trials of different preventative strategies. It is a collaborative project involving both the infectious diseases department (Dr Bradley Gardiner, Dr Rekha Pai Mangalore) and lung transplant department (Professor Glen Westall).