H. Antretter, D. Höfer, H. Hangler, C. Larcher, J. Margreiter, Ch. Hörmann, G. Pölzl, R. Margreiter, G. Laufer, H. Bonatti

Background: Because of intensified immunosuppression patients are at high risk for infection in the early phase after heart transplantation. In this retrospective study the efficacy of a three months lasting antiviral cytomegalovirus (CMV) prophylaxis was evaluated.

Patients and methods: Between 1997 and October 2002 123 patients received a three months lasting combined intravenous and oral CMV prophylaxis with Ganciclovir after HTX (group II). They were compared to a historical group consisting of 40 patients, being transplanted during 1995-1996 (group I; CMV-prophylaxis: hyperimmune globuline for the first postoperative month in combination with orally administered aciclovir for 6 months).

Demographic data of patients and donors were comparable in both groups except underlying cardiac diseases (p=0.015). All organ recipients had identical immunosuppressive regimes postoperatively.

Results: Group II had a significant lower mortality rate (GI: 37.5%, GII 10.6%; p<0.001); one year survival (p=0.0002) and overall survival (p=0.0004) was better than in group I. Patients of group II had less rejection episodes ³ grade II ISHLT requiring treatment (p<0.001).

Group II presented significant less positive CMV blood samples (p=0.006), CMV infections (26% versus 47,5% in GI; p=0.008), and a later onset of infection after HTX than group I (group I with a mean of 5.8 weeks after HTX, group II: 24.8 weeks after HTX; p<0.001).

Conclusion: Incidence of CMV infections was significantly reduced under ganciclovir prophylaxis, infections were shifted into a later period after HTX in which patients are immunologically more competent. The proportion of higher grade rejection episodes was markedly reduced and patients presented an improved survival.

Key words: cytomegalovirus, heart transplantation, antiviral prophylaxis

Ass. Prof. Dr. Herwig Antretter

Klinische Abteilung für Herzchirurgie

Universitätsklinik für Chirurgie

Medizinische Fakultät der Universität

Anichstr. 35

A-6020 Innsbruck

Österreich, E-mail: herwig.antretter@bitte-keinen-spamuibk.ac.at

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