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. Patients and methods: 133 patients received a three-month combined intravenous and oral CMV prophylaxis with Ganciclovir (Cymevene(R)) after HTX between 1997 and April 2003 (group 11). They were compared to a historical group consisting of 40 patients, who had undergone HTX between 1995 and 1996 (group 1; CMV-pro-phylaxis: hyperimmune globuline (Cytotect(R)) for the first post-operative month in combination with orally administered aciclovir (Zovirax(R)) 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 11 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 11 had fewer rejection episodes greater than or equal to grade II ISHLT requiring treatment (p<0.001). Group 11 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 11: 24.8 weeks after HTX; p < 0.001). Conclusion: 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.