Intravenous ganciclovir prophylaxis for cytomegalovirus in heart, heart-lung, and lung transplant recipients

Cytomegalovirus (CMV) disease has had a significant clinical impact on the heart, heart-lung and lung transplant recipients in our centre. CMV disease has been so severe with CMV antibody-negative heart-lung transplant patien ts receiving organs from CMV antibody-positive donors (CMV-mismatched patie nts) that in 1986 we adopted the policy of not: transplanting CMV-positive organs into CMV-negative heart-lung or lung recipients. In December 1992, w e instituted a policy of providing intravenous ganciclovir (5 mg/kg twice a day for 28 days) during the immediate postoperative period for CMV-mismatc hed heart recipients and CMV antibody-positive heart-lung and lung patients , who have been the patients at greatest risk of severe CMV disease in our centre. A placebo group was not employed because of ethical considerations, ganciclovir having been shown to be effective for the treatment of CMV inf ections among transplant patients. Compared with a historical control group of patients receiving no prophylaxis, prophylactic ganciclovir reduced the incidence of CMV infection (39% vs 91%, P = 0.0006) and CMV disease (17% v s 74%, P = 0.0004) among CMV antibody-positive heart-lung recipients. Proph ylactic ganciclovir did not significantly reduce the incidence of CMV infec tion or disease among heart or isolated lung recipients. Ganciclovir was we ll tolerated, with few adverse reactions. In the case of heart-lung transpl ant patients, one month of intravenous prophylactic ganciclovir significant ly reduced the incidence of both CMV infection and disease when compared wi th patients who received no prophylaxis. With the lung transplant and heart transplant patients, there were no significant differences between the pro phylaxis and nonprophylaxis groups, although there was a consistent trend t owards less infection and disease in the prophylaxis groups.