CYTOMEGALOVIRUS-INFECTION RATE AMONG HEART-TRANSPLANT PATIENTS IN RELATION TO ANTI-THYMOCYTE IMMUNOGLOBULIN INDUCTION THERAPY

During a 2-year period, 49 patients underwent heart transplantation at Rigshospitalet, Copenhagen. Nine (18%) were females and the mean age for all patients was 44 years (range 14-56 years). Immunosuppressive t herapy included cyclosporin, azathioprine and steroids in all patients . 43 patients received in addition short-term (approx. 4 days) inducti on treatment with antithymocyte immunoglobulin (ATG). 17 patients rece ived ATG Fresenius(R), 2.5 mg/kg/day or ATGAM(R), 12.5 mg/kg/day,,wher eas the remaining 26 patients received ATG Merieux(R), 2.5 mg/kg/day. Prophylactic antimicrobial chemotherapy included ceftriaxone, acyclovi r (1 g daily), nystatin, and pyrimethamine in toxoplasmosis mismatch p atients. Serological assays for cytomegalovirus (CMV), Epstein-Barr vi rus, varicella-zoster virus, herpes simplex virus, legionella and toxo plasmosis as well as CMV and bacterial culturing were carried out befo re transplantation, at regular intervals and when clinically indicated . Five patients developed septicaemia. Nine had pulmonary bacterial in fections, including 2 cases of legionella pneumonia. Two had Clostridi um difficile diarrhoea. Three patients had Pneumocystis carinii pneumo nitis. 24 patients (49%) had evidence of CMV infection/reactivation. S even out of 10 CMV mismatch (pos donor/neg recipient) patients and 3 o ut of 12 CMV match (pos donor/pos recipient) patients developed clinic al CMV disease. The rate of CMV infection/reactivation was significant ly higher among patients who had CMV-positive donors (p < 0.01) and am ong patients receiving ATG Merieux(R) induction treatment (p < 0.0001) . Logistic regression analysis showed that both positive CMV donor sta tus and ATG Merieux(R) induction treatment were significant independen t predictors of CMV infection. Six patients (12%) died. Two out of 4 i nfection related deaths could be ascribed to CMV disease.