CYTOMEGALOVIRUS DISEASE AFTER HEART-TRANSPLANTATION - IS ACYCLOVIR PROPHYLAXIS INDICATED

To determine the efficacy of acyclovir prophylaxis in preventing cytom egalovirus (CMV) disease after heart transplantation, the clinical cou rse of 103 patients (ages, 0.1 to 62 years; mean age, 41.8 years; 87 m ales, 16 females) was analyzed. Active CMV infection (defined as a pos itive culture from any site or a fourfold increase in immunoglobulin G antibody titers) occurred in 64% (66/103) and clinical CMV disease (d efined as pathologic evidence of CMV in tissue biopsy or a typical CMV syndrome with fever and two of the following: leukopenia, thrombocyto penia, 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 acyclov ir use, duration and type of induction therapy, donor and recipient CM V status, total steroid dose at 3 and 6 months, azathioprine dose and cyclosporine level at 3 months, age, and sex. In a multivariate regres sion 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 a zathioprine dose at 3 months (p = 0.047) were associated with higher o ccurrence 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 acyc lovir reduced the occurrence of CMV disease after heart transplantatio n.