Passive immunization against cytomegalovirus in allograft recipients. The Rotterdam heart transplant program experience

Abstract

We analyzed the results of passive immunization against CMV in 146 heart transplant recipients. The 65 seronegative recipients were prophylactically treated with anti-CMV immunoglobulins during and after the operation. Twenty-nine of these 65 patients received a seropositive donor heart. CMV infection occurred in 21/65 seronegative and in 40/81 seropositive recipients (difference not significant). The incidence of CMV infection in seronegative recipients of a CMV-matched donor heart (3/34) was significantly lower than in seronegative recipients of a positive donor heart and lower than in seropositive recipients, but no significant difference in infection rate was found between the two latter groups (18/29 vs. 40/81). 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 in the severity of symptoms following primary or secondary infection. There was a higher incidence of CMV disease in all patients who received a heart from a seropositive donor versus a seronegative donor. However, after transplantation of a heart from a seropositive donor the incidence (27%) of CMV disease observed in our passively immunized seronegative patients was the same as in the patients with naturally acquired seropositivity. There was no difference in the prevalence of coronary artery disease between patients with and without CMV infection or disease. We conclude that using the current passive immunization scheme the occurrence of CMV infection and disease is largely dependent on the serostatus of the donor.

Improved long-term survival in Dutch heart transplant patients despite increasing donor age: the Rotterdam experience

“…Initially, cytomegalovirus (CMV) seronegative recipients of the heart from a CMV seropositive donor (i.e., CMV mismatch) received passive immunization with anti‐CMV hyperimmunoglobulin during the first 72 days . From 2003 on, oral valganciclovir was prophylactically administered for 6 months.…”

Toxoplasma gondii Serostatus Is Not Associated With Impaired Long-Term Survival after Heart Transplantation

“…In the early phase of the program, CMV seronegative recipients of the heart of a seropositive donor received passive immunization with anti-CMV immunoglobulins (Cytotect; Biotest Pharma, Dreieich, Germany) during the first 72 days after transplantation ( 24 ). Later on, oral valganciclovir was prophylactically administered for 6 months (or longer in case of rejection treatment) in these CMV mismatched patients.…”

Treatment and prevention of cytomegalovirus infection in heart and lung transplantation: an update

“…With the caveat that most of this supportive evidence derives from observational and or retrospective data analyses, several observational studies have shown that CMVIG treatment in heart transplantation is associated with a significant reduction not only in CMV infection, but also in graft-related outcomes, such as acute rejection and allograft vasculopathy. [61][62][63] Similarly, in the lung transplantation context, the combination of CMVIG with antiviral prophylaxis appears to provide additional protection against CMV disease, immune-mediated graft injury and CARV pneumonia. [64][65][66][67] Nevertheless, widespread utilization of CMVIG is limited by their cost and by the lack of confirmatory evidences from randomized studies.…”