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Cytomegalovirus disease after heart transplantation: is acyclovir prophylaxis indicated?
C C Elkins1, W H Frist, J S Dummer
1Department of Thoracic and Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-5734.
Insights
Acyclovir prophylaxis effectively prevents cytomegalovirus (CMV) disease in heart transplant recipients. This study found acyclovir significantly reduced CMV disease occurrence post-transplant.
Area of Science:
- Cardiology
- Infectious Diseases
- Transplantation Medicine
Background:
- Cytomegalovirus (CMV) infection is a significant complication after heart transplantation.
- Preventive strategies are crucial to reduce CMV-related morbidity and mortality.
Purpose of the Study:
- To evaluate the efficacy of acyclovir prophylaxis in preventing cytomegalovirus disease following heart transplantation.
Main Methods:
- Analysis of clinical data from 103 heart transplant patients.
- Multivariate regression analysis to identify independent predictors of CMV disease.
Main Results:
- Acyclovir prophylaxis was independently associated with freedom from CMV disease (p = 0.029).
- Positive donor CMV status, higher steroid dose, and lower azathioprine dose were linked to increased CMV disease.
- Antilymphocyte induction therapy increased active CMV infection but not CMV disease.
Conclusions:
- Prophylactic acyclovir administration is effective in reducing the incidence of CMV disease after heart transplantation.
- Optimizing immunosuppression and donor CMV status are important considerations in CMV prevention.
Abstract:
To determine the efficacy of acyclovir prophylaxis in preventing cytomegalovirus (CMV) disease after heart transplantation, the clinical course of 103 patients (ages, 0.1 to 62 years; mean age, 41.8 years; 87 males, 16 females) was analyzed. Active CMV infection (defined as a positive culture from any site or a fourfold increase in immunoglobulin G antibody titers) occurred in 64% (66/103) and clinical CMV disease (defined as pathologic evidence of CMV in tissue biopsy or a typical CMV syndrome with fever and two of the following: leukopenia, thrombocytopenia, atypical lymphocytes, and elevated liver function test results in a patient with CMV infection) occurred in 25% (26/103). Independent variables studied included acyclovir prophylaxis, duration of acyclovir use, duration and type of induction therapy, donor and recipient CMV status, total steroid dose at 3 and 6 months, azathioprine dose and cyclosporine level at 3 months, age, and sex. In a multivariate regression analysis, acyclovir prophylaxis was independently associated with freedom from CMV disease (p = 0.029). Positive donor CMV status (p = 0.025), higher total steroid dose at 3 months (p = 0.036), and lower azathioprine dose at 3 months (p = 0.047) were associated with higher occurrence of CMV disease. The use of antilymphocyte induction therapy was associated with an increased occurrence of active CMV infection (p = 0.022) but not CMV disease. The prophylactic administration of acyclovir reduced the occurrence of CMV disease after heart transplantation.