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Updated: Feb 12, 2026
Optimization of the Cuff Technique for Murine Heart Transplantation
Published on: June 26, 2020
Cytomegalovirus infection in heart transplantation: A single center experience
Ignacio A Echenique1, Michael P Angarone2, Jonathan D Rich3
1Department of Infectious Disease, Cleveland Clinic Florida, Weston, FL, USA.
Insights
Extending valganciclovir (VGC) prophylaxis for cytomegalovirus (CMV) infection after heart transplant beyond six months did not lower incidence. Most CMV infections occur within six months after VGC prophylaxis cessation.
Area of Science:
- Immunology
- Infectious Diseases
- Transplantation Medicine
Background:
- Cytomegalovirus (CMV) infection is a significant post-heart transplant complication.
- Prophylaxis strategies, including valganciclovir (VGC), vary.
- The optimal duration of VGC prophylaxis requires further investigation.
Purpose of the Study:
- To evaluate the impact of different durations of valganciclovir (VGC) prophylaxis on the incidence and timing of cytomegalovirus (CMV) infections following heart transplantation.
- To analyze the relationship between VGC duration and CMV infection onset relative to prophylaxis cessation.
Main Methods:
- Prospective cohort study of CMV donor (D) or recipient (R) seropositive heart transplant recipients (2005-2012).
- VGC prophylaxis duration ranged from 3 to 12 months, based on serostatus and immunosuppression.
- Univariate and multivariate logistic regression analyses were performed to assess outcomes.
Main Results:
- Of 130 eligible recipients, 16% developed CMV infection.
- No association found between CMV infection and comorbidities, rejection, or mortality.
- Extending VGC prophylaxis to ≥12 months delayed time to CMV infection onset (median 452 vs 247 days) but did not reduce overall incidence.
- CMV infections predominantly occurred within 6 months after VGC cessation (95% of cases).
Conclusions:
- Prophylaxis with valganciclovir (VGC) for ≥12 months did not decrease the incidence of cytomegalovirus (CMV) infection after heart transplantation compared to ≤6 months.
- The majority of CMV infections post-heart transplant occur within the six months following the cessation of VGC prophylaxis.
Background:
Cytomegalovirus (CMV) infection remains a major complication after heart transplantation with varying prophylaxis strategies employed. We sought to determine the impact of valganciclovir (VGC) duration on the epidemiology of CMV infections after heart transplantation.
Methods:
We performed a prospective cohort study of CMV donor (D) or recipient (R) seropositive heart transplant recipients from 2005 to 2012 who completed VGC prophylaxis, ranging from 3 to 12 months according to serostatus and induction immunosuppression. Univariate and multivariate logistic regression was performed.
Results:
Among 159 heart transplant recipients during the study period, 130 (82%) were eligible for VGC prophylaxis. CMV D/R serostatus was as follows: 24% D+/R-, 30% D+/R+, and 29% D-/R+. 65% and 21% received basiliximab and thymoglobulin induction, respectively, followed by maintenance tacrolimus, mycophenolate mofetil, and prednisone. Twenty-one (16%) recipients suffered CMV infection. There was no association with comorbidities including diabetes mellitus, chronic kidney disease, or mechanical assist devices, nor were there associations with rejection, treatments of rejection, or mortality. When VGC prophylaxis duration was stratified by ≤6 vs ≥12 months, time from heart transplantation to CMV infection was delayed (median 247 vs 452 days, P = .002) but there was no difference in days from VGC discontinuation to onset of CMV infection (median 72 vs 83 days, P = .31). CMV infection occurred most frequently within 6-16 weeks of VGC cessation, and 95% of infections occurred during the 6 months post-prophylaxis period.
Conclusions:
Relative to ≤6 months, ≥12 months of VGC did not reduce incidence of CMV infection and only delayed time to onset. 95% of CMV infection occurs within 6 months after cessation of VGC.
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