Long-term outcome of cytomegalovirus high-risk patients after heart transplantation: comparison between two prophylactic regimes – a single-center experience

Abstract

BACKGROUND: Implantation of a cytomegalovirus (CMV)-positive graft (D+) into a CMV-negative recipient (R–) is a high-risk constellation after heart transplantation (HTX). CMV infection after HTX is associated with increased morbidity, mortality, raised incidence of acute rejection and possibly the development of transplant vasculopathy. In order to further reduce the incidence of CMV infections, a new, antiviral prohylaxis was established in 1997. METHODS: We retrospectively reviewed all mismatched cardiac transplant recipients (D+/R–) who were treated with oral acyclovir combined with CMV-hyperimmune globulin (group I, n = 8, 1995/1996) and compared them with CMV-mismatched (D+/R–) recipients who had postoperatively intravenous ganciclovir and subsequent oral ganciclovir for 90 days (group II, n = 18, 1997–2001). Demographic data of both groups were comparable. The same immunosuppressive regimen was used for the entire study period. RESULTS: Five patients (62.5%) of group I died after a mean of 6.7 ± 7.6 months, 3 patients (37.5%) remain alive for a mean of 80.7 ± 5.2 months after transplantation. In contrast, two patients of group II died (11.1%), whereas 16 patients (88.9%) remain alive for a mean of 41.6 ± 13.0 months (p = 0.004). CMV seroconversion occurred in 6 patients of group I (75%) 7.8 ± 1.9 weeks after HTX and in 9 patients of group II (50%) 44.5 ± 22.7 weeks after HTX (p = 0.01). There were more positive antigenemia tests in group I compared with group II (13.8% vs. 9%, p = NS). Significantly less rejection episodes grade IB or more (ISHLT classification) were noticed in group II (18 of 195 biopsies, 9.2%) than in group I (16 of 89 biopsies, 18.0%) (p = 0.036). CONCLUSIONS: Mortality was significantly lower in the ganciclovir group. Antiviral prophylaxis is able to reduce the incidence and to delay the onset of CMV infection in the high-risk CMV-mismatched population after HTX.