Variabilityinstandardcarefor cytomegaloviruspreventionanddetection inpediatriclungtransplantation:Survey ofeightpediatriclungtransplantprograms Since 1985, lung transplantation has been an important treatment for children with end-stage lungdisease.Mostprotocolsrelatedtoprevention of common infections encountered after trans- plantation have been extrapolated from data in adultlungtransplantrecipients,generallyrepor- ted by single centers. Prior to the introduction of prophylaxis for CMV, viremia developed in Danziger-IsakovLA,FaroA,SweetS,MichaelsMG,AuroraP, MogayzelPJJr,MalloryGBJr,BoyerDM,RiceTB,DelaMorenaM, DeBaunMR,IPLTCGroup.Variabilityinstandardcarefor cytomegaloviruspreventionanddetectioninpediatriclung transplantation:Surveyofeightpediatriclungtransplantprograms. PediatrTransplantation2003:7:469–473. Ó2003BlackwellMunksgaard Abstract:Cytomegalovirus(CMV)infectionafterpediatriclungtrans- plantationisasignificantriskfactorformorbidityandmortalityinthe firstyearaftertransplantation.Multiplestrategieshavebeenreported forCMVpreventionamongadultlungtransplantprograms.Incon- trast,littleinformationhasbeenreportedregardingprotocolsforpre- ventionanddetectionofCMVfrompediatricprograms.Weconducted asurveytobetterunderstandtherangeofpracticepatternsforCMV preventionanddetectionatpediatriclungtransplantcenters.Aself- administeredquestionnairewasdistributedto11pediatriclungtrans- plantcentersidentifiedthroughtheInternationalPediatricLung TransplantCollaborativeinSeptember2002.Amemberofthelung transplantteamfromeachinstitutionwasaskedtoprovidethemethods ofCMVpreventionandsurveillance.Eightof11centerssurveyed respondedtothequestionnaireaccountingfor45.6%(26of57)and 100%(threeofthree)ofthepediatriclungtransplantsperformedinthe USandUKin2001,respectively.Allcentersusedprophylactictherapy againstCMVwitheitherganciclovirorvalganciclovirwithduration rangingfrom3.5wktoindefinitely.Mostcenters(sixofeight)pre- scribedaprophylacticregimenbasedondonorandrecipientCMV serostatus.Half(fourofeight)ofthecentersreportusingCMV hyperimmuneglobulininadditiontoanantiviralagent.Methodfor CMVdetectionvariedwidely,includinguseofconventionalviralcul- ture(n ¼ 1),antigenemia(n ¼ 7),andpolymerasechainreaction (n ¼ 2).AwiderangeofstrategiesisusedtopreventanddetectCMVin pediatriclungtransplantrecipientswithlittleempiricevidencedem- onstratingtheoptimalapproach.Aretrospectiveanalysisamongthese centersisbeingconductedtoevaluatetheefficacyoftheseapproaches. Lara A. Danziger-Isakov 1 , Albert Faro 2 , Stuart Sweet 1 , Marian G. Michaels 3 , Paul Aurora 4 , Peter J. Mogayzel Jr 5 , George B. Mallory Jr 6 , Debra M. Boyer 7 , Tom B. Rice 8 , Maite DelaMorena 1 , Michael R. DeBaun 1 and the International Pediatric Lung Transplant Collaborative Group 1 Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, MO, USA, 2 Department of Pediatrics, University of Florida, Gainesville, FL, USA, 3 Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA, 4 Great Ormond Street Hospital for Children and Institute of Child Health, London, UK, 5 Department of Pediatrics, The Johns Hopkins University Hospital, Baltimore, MD, USA, 6 Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA, 7 Department of Pediatrics, Harvard University and Boston Children's Hospital, Boston, MA, USA, 8 Department of Pediatrics, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, WI, USA Key words: lung transplantation – cytomegalovirus – pediatrics – standard care Lara A. Danziger-Isakov, MD, Department of Pediatrics, 4120, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. Tel.: (216) 636-1077 Fax: (216) 445-7792 E-mail: danzigl@ccf.org Accepted for publication 19 June 2003 Abbreviations: CMV, cytomegalovirus; CMVIG, cytomeg- alovirushyperimmuneglobulin;D,donor;GCV,ganciclo- vir;IV,intravenous;mg/kg,milligramperkilogram;PCR, polymerase chain reaction; POD, post-operative day; R, recipient; US, United States; VGCV, valganciclovir; UK,UnitedKingdom. Pediatr Transplantation 2003: 7: 469–473 Printed in UK. All rights reserved Copyright Ó 2003 Blackwell Munksgaard Pediatric Transplantation 469