454Cytomegalovirus (CMV) Disease after Lung Transplantation (LT) is associated with increased mortality despite Extended Antiviral Prophylaxis

Background. The duration of anti-CMV after LT varies widely among transplant centers. Because CMV is associated with poor outcome, some centers have extended prophylaxis to reduce the rates of CMV disease. We aimed to assess the epidemiology and outcome of CMV infection in high-risk LT recipients receiving extended (and for some, lifelong) prophylaxis. Methods. This is a retrospective review of CMV D + /Rand R+ LT recipients during January 2005 to September 2012. Starting in January 2007, valganciclovir prophylaxis was given lifelong for CMV D + /Rand 6 months for R+ LT patients. The risks of CMV infection and disease were assessed for association with the duration of prophylaxis using Cox proportional hazard models. In addition we used similar models to identify risk factors for mortality, including the time-dependent covariates of CMV prophylaxis, CMV infection and disease, and age, sex, and Charlson comorbidity score. Results. A total of 88 LT patients were at risk of CMV disease, including 32 CMV D + /R-, and 56 R+ LT patients (40 CMV D + /R + ; 16 CMV D-/R+). The median age at LT was 49 (IQR, 51-63) years; 49 (55.7%) were female. The most common indications for LT were chronic obstructive pulmonary disease (n = 27) and idiopathic pulmonary fibrosis (n = 25). CMV infection occurred in 11, while CMV disease occurred in 9 patients. Use and duration of CMV prophylaxis was not significantly associated with mortality. Significant factors for mortality were CMV disease [HR 4.19 (95% CI: 1.67-10.495), p = 0.002], and CMV infection and disease [HR 3.78 (95% CI: 1.73-8.24), p = 0.001]. The associations with these risk factors were not qualitatively impacted by prophylaxis. There was no significant difference in mortality between CMV D + /Rand R+ LT recipients. Conclusion. CMV infection continues to occur in LT patients despite extended antiviral prophylaxis. It remains to be significantly associated with a higher rate of mortality. Better strategies to improve its prevention may lead to a better outcome among LT recipients. Disclosures. All authors: No reported disclosures.