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Comparison of intravenous ganciclovir and cytomegalovirus hyperimmune globulin pre-emptive treatment in cytomegalovirus-positive heart transplant recipients

Authors
Journal
The Journal of Heart and Lung Transplantation
1053-2498
Publisher
Elsevier
Publication Date
Volume
23
Issue
4
Identifiers
DOI: 10.1016/s1053-2498(03)00200-6
Keywords
  • Transplantation Infection
Disciplines
  • Medicine

Abstract

Abstract Background We compared the use of intravenous ganciclovir and cytomegalovirus hyperimmune globulin (CMVIG) as a pre-emptive treatment for cytomegalovirus (CMV)-positive heart transplant recipients. Methods Of 59 CMV-seropositive adult heart transplant recipients enrolled in Group 1, 37 tested positive for pp65 antigen within 12 weeks post-transplantation. These patients were randomized to receive either intravenous ganciclovir ( n = 23) or CMVIG ( n = 14). Group 2 included 133 CMV-seropositive heart transplant recipients who were not tested for CMV antigenemia and who received no anti-CMV therapy. Results CMV disease developed in 0 of 59 patients from Group 1, and in 27 of 133 patients (20%) in Group 2 ( p = 0.0001). The incidence of superinfections was lower in Group 1 (0.28 ± 0.46) than in Group 2 (1.10 ± 1.33) ( p = 0.01). The 2 groups did not differ with regard to incidence of rejection (0.7 ± 0.9 in Group 1 vs 1.0 ± 1.2 in Group 2; p = NS), transplant coronary artery disease at 1 year (14% in Group 1 vs 16% in Group 2; p = NS) or post-transplant lymphoproliferative disease (0% in Group 1 vs 2% in Group 2; p = NS). Ganciclovir and CMVIG therapies were associated with similar rates of rejection (0.52 ± 0.6 with ganciclovir vs 0.50 ± 0.60 with CMVIG; p = NS), superinfection (0.30 ± 0.48 with ganciclovir vs 0.25 ± 0.46 with CMVIG; p = NS), and transplant coronary artery disease at 1 year (13% with ganciclovir vs 14% with CMVIG, p = NS). Conclusions The pre-emptive anti-CMV approach is superior to prophylaxis in CMV-seropositive heart transplant recipients. Both ganciclovir and CMVIG are equally effective.

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