Increased risk of CMV infection in heart transplant patients on mycophenolate mofetil

Abstract

plantation (grp II, n58). Methods: Patients receiving HCV positive allografts between July 1994 to Dec. 1999 were reviewed. The HCV RNA level, seroconversion of anti-HCV antibody, hepatic enzymes, correlation of liver dysfunction and cause of death were examined. Survival and transplant coronary artery disease (TCAD) free rate were compared with age matched patients transplanted in the same period (n5 392). Results: The recipients consisted of 17 males and 1 female, with median age 54 yrs for grp I and 66 for grp II; 2 pts in grp II who were pretransplant HCV positive were also retransplants. Hospital mortality rate was 1/10 in grp I and 2/8 in grp II(total517 %), all from multiple organ failure. All survivors were HCV negative prior to transplant. At a median follow up of 26.5 months, 6/15 survivors (40 %) were infected with detectable viremia. Three(20 %) seroconverted after 1-13 months and two, one per grp, developed HCV related liver dysfunction. One from grp I developed fibrosing cholestatic hepatitis and expired. Actuarial 3 yr survival in those discharged is 56% and 84% for grp I and II. Freedom from rejection (.grade 3) was 40% for grp I and 100% for grp II. TCAD accounted for 2 late deaths in persistently seronegative but viremic pts in grp I and none in grp II. Overall 3-year TCAD free rate was 87% for the 15 patients discharged. Conclusions: (1) Under TDI, hepatitis C transmission using donor heart as the reservoir is moderate with seroconversion lower. (2) Limited use of such donors is justified in selected patients. (3) Seroconversion and risk for hepatic disease may be reduced by tailoring immunosuppression particularly if they are at low risk of rejection.