IS ROUTINE POSTOPERATIVE SURVEILLANCE FOR CYTOMEGALOVIRUS-INFECTION FOLLOWING HEART-TRANSPLANTATION NECESSARY

Objective: Cytomegalovirus infection (CMV) is an important cause of mo rbidity and mortality following cardiac transplantation. The purpose o f the present study was to ascertain whether routine post-operative sc reening for CMV infection influenced clinical management. Methods: Lab oratory and case notes of 220 patients who received cardiac transplant ation between November 1986 and October 1996 were reviewed. The range of follow-up was one to 120 (median 36) months. CMV surveillance invol ved blood tests for early antigen detection weekly for the first 6 pos t-operative weeks, fortnightly thereafter until the end of the third p ost-operative month and every 6 weeks to the end of the first post-ope rative year. Otherwise monitoring was performed if the patients had cl inical symptoms suggestive of CMV infection. CMV sere-negative IgG rec ipients (R) of sere-positive IgG donor (D) organs and/or blood product s received hyper-immune gammaglobulin for the first three post-operati ve months. Four patient groups were noted, namely R+D+ (59 patients), R+D- (70 patients), R-D+ (35 patients) and R-D- (56 patients). Results : CMV antigenaemia was present in 40% (89) of patients and 48% (43) of these patients developed clinical features of CMV infection and recei ved ganciclovir therapy. The distribution of clinical CMV infection re quiring treatment was 25% (9/35) in the R+D- group, 50% (16/32) in the R+D+ group and 85% (18/22) in the R-D+ group. None of the patients in the R-D- group developed CMV antigenaemia. Forty six (52%) patients w ho were CMV antigen positive but who did not develop symptoms were not treated with ganciclovir and have remained well. Conclusion: Our resu lts suggest that routine screening for CMV following cardiac transplan tation is unnecessary. Surveillance did not result in the instigation of treatment for CMV unless there were associated clinical features of CMV infection. (C) 1998 Elsevier Science B.V. All rights reserved.