Should heart-lung transplant donors and recipients be matched according to cytomegalovirus serologic status?
Cytomegalovirus (CMV) infection is a major cause of morbidity and mortality after heart-lung transplantation. Primary CMV infections in previously seronegative recipients are more severe than reactivated or reinfections in seropositive patients, and this has led to a policy of obligatory donor-recipient CMV matching in several centers performing heart-lung transplantation. Of our 13 heart-lung transplants, three were done in CMV-seronegative patients who received CMV-positive grafts. The first patient did not seroconvert and exhibited no evidence of CMV infection despite close follow-up extending to almost 2 years. In the second patient, who required augmented immunosuppression because of recurrent lung rejection early postoperatively, fulminating CMV pneumonitis developed, which was ultimately controlled with ganciclovir and high-dose CMV immune globulin. As an outpatient, she is currently receiving ganciclovir maintenance therapy. The third patient, who received high-dose CMV immune globulin prophylaxis, had CMV isolated from her bronchoalveolar lavage fluid, as well as from urine, but remains clinically well 5 months after receiving her transplant. We conclude that the matching of donors and recipients for CMV serologic status is desirable, but not essential, before heart-lung transplantation. CMV immune globulin prophylaxis may be effective in preventing clinical CMV disease in patients receiving a CMV-mismatched graft, and severe CMV pneumonitis may be effectively treated by a combination of ganciclovir and high-dose CMV immune globulin therapy.
Novick
R J
RJ
Division of Cardiovascular-Thoracic Surgery, University Hospital, London, Ontario, Canada.
Menkis
A H
AH
McKenzie
F N
FN
Reid
K R
KR
Ahmad
D
D
D000328:Adult; D000914:Antibodies, Viral / Q000032:analysis; D002648:Child; D003587:Cytomegalovirus / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000517:prevention & control; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D016041:Heart-Lung Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D011024:Pneumonia, Viral / Q000382:microbiology* / Q000517:prevention & control; D014019:Tissue Donors
D000914:Antibodies, Viral; D007166:Immunosuppressive Agents; D015774:Ganciclovir