High Incidence of Cytomegalovirus Disease in D+/R− Heart Transplant Recipients Shortly After Completion of 3 Months of Valganciclovir Prophylaxis

Gupta, Sachin; Mitchell, Joshua D.; Markham, David W.; Mammen, Pradeep P.A.; Patel, Parag C.; Kaiser, Patricia; Ring, W. Steves; DiMaio, J. Michael; Drazner, Mark H.

doi:10.1016/j.healun.2008.02.002

« Previous Next »The Journal of Heart and Lung Transplantation
Volume 27, Issue 5 , Pages 536-539, May 2008

High Incidence of Cytomegalovirus Disease in D⁺/R⁻ Heart Transplant Recipients Shortly After Completion of 3 Months of Valganciclovir Prophylaxis

Sachin Gupta, MD
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
Joshua D. Mitchell, BS
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
David W. Markham, MD
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
Pradeep P.A. Mammen, MD
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
Parag C. Patel, MD
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
Patricia Kaiser, RN
- Cardiac Transplant Program, University Hospital–St. Paul, University of Texas Southwestern Medical Center, Dallas, Texas
W. Steves Ring, MD
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
J. Michael DiMaio, MD
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Mark H. Drazner, MD, MSc
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- Reprint requests: Mark H. Drazner, MD, MSc, Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9047. Telephone: 214-645-7500. Fax: 214-645-7501.

Received 26 November 2007; received in revised form 29 January 2008; accepted 6 February 2008.

Background

Cytomegalovirus (CMV) infection remains a serious problem after heart transplantation. Recipients with D⁺/R⁻ CMV serostatus often receive prophylaxis with valganciclovir, but the optimal duration of such therapy after heart transplant is unknown.

Methods

We retrospectively reviewed the clinical course of all adult cardiac transplant recipients with D⁺/R⁻ CMV serostatus at the UT Southwestern Medical Center between January 2003 and December 2006. Standard immunosuppression included basiliximab induction therapy and the CMV prophylaxis included CMV hyperimmune globulin, 2 weeks of intravenous ganciclovir and 3 months of oral valganciclovir.

Results

Seven patients met the study criteria. Six of the 7 patients (86%) developed CMV disease. Five of these 6 patients presented with CMV disease within 3 months of the cessation of valganciclovir prophylaxis.

Conclusions

There was a high incidence of CMV disease in D⁺/R⁻ heart transplant recipients despite CMV hyperimmune globulin, 2 weeks of intravenous ganciclovir and 3 months of valganciclovir prophylaxis. CMV infection occurred consistently within 2 to 3 months of cessation of valganciclovir. Alternative strategies for CMV prophylaxis, including an extension of valganciclovir prophylaxis to 6 months after heart transplantation, needs to be investigated.