Cytomegalovirus Seronegative Heart Transplant Recipients

7 Apr

Сytomegalovirus infection remains a major problem after clinical heart transplantation. Especially primary infections may result in serious morbidity and even mortality. Primary infections result from transmission of the virus with an allograft or with blood products from CMV seropositive donors into CMV seronegative recipients. The incidence of CMV disease in the CMV seropositive heart donor/seroneg- ative recipient combination has been reported to be 64-92 percent. In the seronegative heart recipients from a seronegative donor, the incidence is still 15 percent. Avoidance of CMV transmission by select­ing CMV seronegative allograft and blood donors for CMV seronegative recipients will prevent primary CMV infection after transplantation. However, this strategy is not always logistically feasible and it can prolong the time on the waiting list, which is often unacceptable for critically ill heart transplant candi­dates. Consequently, other methods to prevent CMV infection have to be evaluated. Prophylactic use of antiviral agents is a possibility. However, reports on the efficacy of acyclovir are controversial, and neither interferon a nor interferon £ reduced the incidence of CMV disease, while interferon a was associated with severe acute rejections.

Moreover, the wide­spread use of ganciclovir, although effective in the treatment of CMV disease, could result in ganciclovir- resistant CMV strains1 and in myelosuppression associated superinfections. Active immunization of se­ronegative kidney transplant candidates with an atten­uated live CMV strain did not prevent CMV infection nor CMV disease after transplantation, although the symptomatic infections did run a milder course in these patients than in their seronegative nonimmuni- zed control subjects. Passive immunization with anti-CMV immunoglobulin preparations reduced the severity of CMV disease in seronegative kidney recip­ients from seropositive donors. These studies confirm earlier observations in bone marrow trans­plant recipients. The value of passive immunization for heart transplant recipients is unclear as only limited and inconclusive results have been published on this subject. Therefore, it was decided to accrue arguments for its efficacy in CMV seronegative heart transplant patients, in which the expected incidence of disease is high, especially in case of a CMV seropositive donor (36 of 44, 82 percent). viagra plus