PASSIVE-IMMUNIZATION AGAINST CYTOMEGALOVIRUS IN ALLOGRAFT RECIPIENTS - THE ROTTERDAM HEART-TRANSPLANT PROGRAM EXPERIENCE

We analyzed the results of passive immunization against CMV in 146 hea rt transplant recipients. The 65 seronegative recipients were prophyla ctically treated with anti-CMV immunoglobulins during and after the op eration. Twenty-nine of these 65 patients received a seropositive dono r heart. CMV infection occurred in 21/65 seronegative and in 40/81 ser opositive recipients (difference not significant). The incidence of CM V infection in seronegative recipients of a CMV-matched donor heart (3 /34) was significantly lower than in seronegative recipients of a posi tive donor heart and lower than in seropositive recipients, but no sig nificant difference in infection rate was found between the two latter groups (18/29 vs. 40/8 1). Although primary infection more frequently resulted in CMV disease than secondary infection (11/21 vs. 10/40) no difference in incidence of disease was noted between seronegative and seropositive patients (11/65 vs. 10/81), nor was there a difference i n the severity of symptoms following primary or secondary infection. T here was a higher incidence of CMV disease in all patients who receive d a heart from a seropositive donor versus a seronegative donor. Howev er, after transplantation of a heart from a seropositive donor the inc idence (27%) of CMV disease observed in our passively immunized serone gative patients was the same as in the patients with naturally acquire d seropositivity. There was no difference in the prevalence of coronar y artery disease between patients with and without CMV infection or di sease. We conclude that using the current passive immunization scheme the occurrence of CMV infection and disease is largely dependent on th e serostatus of the donor.