PROPHYLACTIC GANCICLOVIR TREATMENT REDUCES FUNGAL AS WELL AS CYTOMEGALOVIRUS INFECTIONS AFTER HEART-TRANSPLANTATION

Cytomegalovirus (CMV) infection is associated with an increased incide nce of other opportunistic infections in organ transplant recipients. Whether this is related to immunomodulating effects of CMV or independ ent of CMV but associated with a host risk factor common to both infec tions is unclear. The purpose of this study was to determine whether t he reduction in CMV infections seen with prophylactic ganciclovir trea tment after heart transplantation is associated with a reduced inciden ce of other opportunistic infections. Of 149 patients prospectively en rolled in a multicenter, randomized, double-blind, placebo-controlled trial of ganciclovir to prevent CMV disease, 74 patients enrolled at t his center (33 control and 41 ganciclovir-treated) were retrospectivel y identified. All received prophylactic OKT-3 and standard 3 drug main tenance immunosuppressive therapy. Actuarial survival and rejection ra tes and incidence of opportunistic infections (bacterial, fungal, and protozoal) for the 2 treatment groups were determined and compared usi ng Cox-Mantel analysis. CMV disease occurred 2.5 times more frequently in the control group. There were no significant differences in surviv al or rejection rates nor in bacterial or protozoal infection incidenc e between the 2 groups. Bacterial infections occurred in 54% of contro l and 39% of ganciclovir-treated patients (P=0.18). There were signifi cantly fewer fungal infections in the ganciclovir-treated group (7% vs , 27%, P=0.0071). CMV and fungal infections were both significantly re duced in patients who received ganciclovir prophylaxis. This suggests that active CMV disease may be causally associated with the developmen t of opportunistic fungal infections.