[Is it possible to reduce CMV-infections after heart transplantation with a three-month antiviral prophylaxis? 7 years experience with ganciclovir].
BACKGROUND
In the early phase after heart transplantation (HTX) patients are at high risk for infection because of intensified immunosuppression. This retrospective study evaluates the efficacy of a three-month antiviral cytomegalovirus (CMV) prophylaxis.


METHODS
133 patients received a three-month combined intravenous and oral CMV prophylaxis with Ganciclovir (Cymevene after HTX between 1997 and April 2003 (group II). They were compared to a historical group consisting of 40 patients, who had undergone HTX between 1995 and 1996 (group I; CMV-prophylaxis: hyperimmune globuline (Cytotect) for the first post-operative month in combination with orally administered aciclovir (Zovirax) for 6 months). Demographic data of organ recipients and donors in both groups were comparable, except for underlying cardiac diseases (p = 0.016). All patients had identical postoperative immunosuppressive regimes.


RESULTS
Group II had a significantly lower mortality rate (GI: 37.5%, GII: 9.8%; p < 0.001); one year survival (p = 0.001) and overall survival (p = 0.001) were significantly better than in group I. Patients of group II had fewer rejection episodes > or = grade II ISHLT requiring treatment (p < 0.001). Group II presented significantly fewer positive CMV blood samples (p = 0.005) and CMV infections (26% versus 47,5% in GI; p = 0.008), and a later onset of infections after HTX than group I (group I with a mean interval of 5.8 weeks after HTX, group II: 24.8 weeks after HTX; p < 0.001).


CONCLUSIONS
Incidence of CMV infection was significantly lowered under ganciclovir prophylaxis, infections occurred at a later time point after HTX, when patients were immunologically more competent. The proportion of higher grade rejection episodes was markedly reduced and survival was improved.
Antretter
Herwig
H
Klinische Abteilung für Herzchirurgie, Universitätsklinik fur Chirurgie, Medizinische Fakultät der Universität Innsbruck, Innsbruck, Osterreich. herwig.antretter@uibk.ac.at
Höfer
Daniel
D
Hangler
Herbert
H
Larcher
Clara
C
Pölzl
Gerhard
G
Hörmann
Christoph
C
Margreiter
Josef
J
Margreiter
Raimund
R
Laufer
Günther
G
Bonatti
Hugo
H
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D019072:Antibiotic Prophylaxis / Q000379:methods*; D001317:Austria / Q000453:epidemiology; D015984:Causality; D002648:Child; D003586:Cytomegalovirus Infections / Q000401:mortality* / Q000517:prevention & control*; D018572:Disease-Free Survival; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage*; D016027:Heart Transplantation / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome
D015774:Ganciclovir