EFFECTS OF PREEMPTIVE THERAPY IN HEART TRANSPLANT PATIENTS WITH CYTOMEGALOVIRUS - ANTIGENEMIA

Abstract

392 Preemptive antiviral therapy in patients with cytomegalovirus (CMV) -antigenemia offers a new alternative in prevention of CMV disease, one of the major complications after heart transplant. We reviewed a study group of 22 heart transplant patients who received preemptive therapy for positive CMV antigenemia in comparison to a historical control group of 20 heart transplant patients followed prior to the availability of CMV antigenemia assay. Study group patients received ganciclovir, 5 mg/kg/day bid IV for 7 days or Cytogam 200 mg/kg as a single dose, upon detection of one or more antigen-positive cells per 5 × 104 peripheral blood leukocytes examined. Patients were monitored weekly after heart transplant. Among control group patients, only CMV seronegative recipient of heart from CMV seropositive donor (R−D+) received prophylactic therapy. All patients received ganciclovir for CMV disease diagnosed by biopsy or clinical presentation. The groups were comparable with respect to donor CMV serostatus, age, sex, induction therapy, immunosuppression regimen and incidence of rejection. There were seven R−D+ patients in the study group vs. two R−D+ patients in control group. Only one patient of the seven R−D+ in study group developed CMV disease. CMV antigenemia was detected in 21 of 22 study group patients. Two study group patients were hospitalized for CMV disease (total 30 days), compared to seven control group patients (total 97 days), p=0.04. Patient charges (antigen test + therapy + room charge) in study group were 43% less than in control group. This preliminary data suggests that the use of preemptive antiviral therapy in heart transplant patients may decrease the incidence of CMV disease and result in reduced costs. A further analysis of a larger patient population is warranted.