[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.
Klinische Abteilung für Herzchirurgie, Universitätsklinik fur Chirurgie, Medizinische Fakultät der Universität Innsbruck, Innsbruck, Osterreich. herwig.antretter@uibk.ac.at
Herwig
H
Antretter
Daniel
D
Höfer
Herbert
H
Hangler
Clara
C
Larcher
Gerhard
G
Pölzl
Christoph
C
Hörmann
Josef
J
Margreiter
Raimund
R
Margreiter
Günther
G
Laufer
Hugo
H
Bonatti
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