MONITORING OF CYTOMEGALOVIRUS DISEASE AFTER HEART-TRANSPLANTATION - PERSISTENCE OF ANTICYTOMEGALOVIRUS IGM ANTIBODIES

During the first year after orthotopic heart transplantation 39 recipi ents (given prophylactic immunosuppression with antithymocyte globulin for 7 days after orthotopic heart transplantation and triple drug mai ntenance therapy) were screened for cytomegalovirus antigenemia and an ti-cytomegalovirus immunoglobulin M (index) and immunoglobulin G level s (antibody units) by MEIA-method. Until day 14, all recipients receiv ed cytomegalovirus hyperimmunoglobulin at a dosage of 2 ml/kg/day. Fou r patient groups were defined: group 1 (n = 15) seropositive recipient /seropositive donor, group 2 (n = 9) seronegative recipient/seropositi ve donor, group 3 (n = 8) seropositive recipient/seronegative donor an d group 4 (n = 7) seronegative recipient/seronegative donor. Twenty-fo ur donors and 23 recipients were seropositive for anti-cytomegalovirus immunoglobulin G. After transplantation, 31 recipients tested positiv e for cytomegalovirus antigenemia before immunoglobulin M elevation an d at least 7 days before the onset of clinical symptoms of cytomegalov irus. In group 2, episodes of cytomegalovirus antigenemia appeared ear lier, were more frequent, and lasted longer than in groups 1 and 3. Wi thout previous evidence of positive cytomegalovirus antigenemia testin g, no sign of cytomegalovirus disease was seen. When cytomegalovirus a ntigenemia was positive, cytomegalovirus hyperimmunoglobulin was readm inistered at the same dosage and gancyclovir (1000 mg/day) was given u ntil cytomegalovirus antigenemia disappeared. However, episodes of rec urrent cytomegalovirus were observed (2.6 +/- 1.9, 4.3 +/- 1.0, and 2. 3 +/- 1.2 in groups 1, 2 and 3, respectively). In groups 1 and 3, the anti-cytomegalovirus immunoglobulin G antibody level remained high dur ing the observation period. In groups 2 and 4 anti-cytomegalovirus imm unoglobulin G antibodies were positive because of hyperimmunoglobulin prophylaxis but immunoglobulin G decreased again after discontinuation of the prophylaxis. In group 2 (presumably primary infection) and in six recipients of group 1 (presumably superinfection), anti-cytomegalo virus immunoglobulin M antibodies that appeared - in these cases gener ally later - (day 90 +/- 17 in group 1 versus day 52 +/- 9 in group 3; p < 0.05) were higher (group 1, 5.5 +/- 1.2, versus group 3, 1.9 +/- 0.5; p < 0.02) and persisted during the first year after orthotopic he art transplantation. The presence and persistence of immunoglobulin M were observed only in recipients of seropositive donors.