Is the incidence of cytomegalovirus disease following heart transplantation decreased by prophylactic ganciclovir and CMV-hyperimmunglobulin?

Ganciclovir (DHPG) was used for the prophylaxis of CMV disease after heart transplantation (HTx) in 20 patients (aged 52 +/- 8 years old). DHPG was used during the first 2 weeks post HTx, and during antirejection therapy with OKT3 or thymoglobulin (ATG), at a dosage of 3 mg/kg q 12 h in the case of a CMV+ donor (D) and/or CMV+ recipient (R). CMV-hyperimmunglobulin (-Ig, 1 ml/kg per week for 6 weeks) was added in the case of a CMV+ donor. A historical control group included 18 HTx patients (aged 53 +/- 10 years old). We excluded the combination of CMV- donor and CMV- recipient. Both groups received the same immunosuppression with methylprednisolone (MP), azathioprine, ATG, and cyclosporine A. The global incidence of CMV disease was 15% (3/20 patients) in the study group and 11% (2/18 patients) in the control group. Similar results were observed in the D+/R- combination (study group 40%, 2/5 patients; control group, 25%, 2/8 patients) and in cases of R+ irrespective of D status (study group, 7%, 1/15 patients; control group 0%, 0/10 patients). No difference was observed in both groups with respect to the incidence of CMV disease after antirejection therapy either with MP or with OKT3/ATG. At 1 year post HTx, no difference was found in the incidence of acute rejection, coronary artery disease or other etiology of infection or mortality. All patients CMV disease responded to a 14-day course of DHPG (5 mg/kg q 12 h). No relapsing disease was observed, and no patient died from CMV. Our results suggested that at the doses and time-scale used, DHPG, with or without CMV-Ig did not reduce the incidence of CMV disease after HTx.