Interactive Case Study

CMV Lung Transplant

Welcome to the Viracor Case Study Experience

Step inside a real-world clinical journey and explore how diagnostic insights can shape decisions in transplant care. This interactive experience follows a CMV lung transplant case from presentation through management—highlighting critical moments, testing strategies, and the impact of timely, informed choices.

As you move through each stage, your Viracor representative will guide you through the case, offering context, perspective, and opportunities to engage with the data.

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Case History

Your patient is a 65-year-old male who underwent bi-lateral lung transplant (CMV +/+) for end stage lung disease secondary to non-CF bronchiectasis.  

Initial peri-operative course complications:

  • Difficult explant
  • Primary graft dysfunction
  • Respiratory failure requiring prolonged mechanical ventilation
  • Renal insufficiency
  • Recurrent infectious concerns:
    • Pseudomonas pneumonia
    • Stenotrophomonas pneumonia

 

 

 

 

Institutional Protocols

Institutional Protocol for R+ Tx:

  • R+ lung transplant recipients: minimum 6 months of VGCV prophylaxis
  • Institutional protocol for R+ transplants:
  • IV GCV pre-operative and POD0
  • Transition to VGCV once cleared for enteral nutrition
  • Dosed per renal function
  • Duration:
  • D+/R+: 12 months
  • D+/R-: 12 months
  • D-/R+: Valacyclovir x12 months

Patient Regimen

Immunosuppression:
The patient was maintained on institutional post-lung transplant regimen, including:

  • Tacrolimus: 8–10 in first year, adjusted for renal failure
  • Mycophenolate: 1000 mg q12hr
  • Prednisone: gradual taper to baseline 5 mg/day by 6 months

Prophylaxis:

  • Bactrim DS every Monday, Wednesday, Friday
  • Voriconazole x4 months
  • Valganciclovir x12 months

 

Summation (Post-Transplant)

  • Pre-transplant, the patient’s white blood cell count was normal.
  • While on Valganciclovir post-transplant, the patient became leukopenic and Neupogen was administered for neutropenia (nadir 0.65 K/uL).
  • At 6 months post-transplant, the patient underwent acute cellular rejection (A2) and was treated with pulse dose corticosteroids.

 

 

 

 

 

 

 

Clinical Testing

Due to the continued leukopenia, at 9 months post lung transplant, the Viracor CMV inSIGHT T-Cell Immunity Panel was ordered.
  • CD4 interferon-gamma response above reference range (0.20%)
  • CD8 interferon-gamma response above reference range (0.20%)
  • CMV specific immune response was detected
  • Patient removed from valganciclovir prophylaxis (3 months earlier than protocol)
.

Progress After

Resolution & Outcome:

  • Near immediate resolution of neutropenia/leukopenia
  • Resumption of goal mycophenolate dosing; no further cytopenias or rejection
  • Continued to monitor for evidence of CMV DNAemia post valganciclovir discontinuation

 

 

 

Final Summation

Your highly immunosuppressed lung transplant patient experienced untoward adverse effects of protocol prophylaxis, necessitating down-titration of immunosuppression. Unfortunately, they developed acute cellular rejection while immunosuppression was reduced.

Demonstration of CMV immunity led to deviation from prophylaxis protocol and early discontinuation of valganciclovir. There was a resolution of adverse effects and resumption of full immunosuppression.

Although the patient developed persistent, short-term, mild CMV DNAemia, it was able to be resolved with known CMV immunity utilizing the CMV inSIGHT™ T Cell Immunity test.

Citation: Rosenheck J. 2022. CMV Immunity Testing in a Lung Transplant Recipient.

Relevant Testing

CMV inSIGHT

CMV inSIGHT™ T Cell Immunity
Review of some of the testing utilized for this patient reviewed in the case study:
  • CMV PCR:
    Deliver confident, timely CMV viral load insights with Viracor's CMV PCR assay to detect and act on infection dynamics earlier to support optimal patient management.
  • CMV T Cell Immunity Panel:
    Elevate CMV risk assessment beyond viral load with CMV inSIGHT TCIP, providing a functional measure of cell-mediated immunity to potentially help personalize prophylaxis and treatment decisions across the transplant continuum

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