Infection

, Volume 21, Issue 4, pp 195–200 | Cite as

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

  • A. H. M. M. Balk
  • Karin Meeter
  • B. Mochtar
  • M. L. Simoons
  • W. Weimar
  • H. J. Metselaar
  • Ph. H. Rothbarth
Originalia

Summary

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.

Passive Immunisierung gegen Cytomegalovirus bei Herztransplantatempfängern. Erfahrungen des Rotterdam Heart Transplant Program

Zusammenfassung

An 146 Herztransplantationspatienten untersuchten wir den Effekt passiver Immunisierung gegen CMV. Die 65 seronegativen Herzempfänger wurden peri- und postoperativ prophylaktisch mit Anti-CMV-Immunglobulin behandelt. 29 dieser 65 Patienten erhielten ein seropositives Spenderherz. Bei 21 von 65 seronegativen und bei 40 von 81 seropositiven Empfängern kam es zur Infektion (Unterschied nicht signifikant). Die Inzidenz von CMV-Infektionen war bei seronegativen Empfängern eines entsprechenden Spenderherzens (3/34) signifikant niedriger als bei seronegativen Empfängern eines positiven Spenderherzens und niedriger als bei seropositiven Empfängern, jedoch ergab sich kein signifikanter Unterschied zwischen den beiden letztgenannten Gruppen (18/29 versus 40/81). Obwohl primäre Infektionen häufiger zur CMV-Erkrankung führten als sekundäre Infektionen (11/21 versus 10/40), ergab sich kein Unterschied in der Häufigkeit seronegativer und seropositiver Patienten (11/65 versus 10/81), oder im Schweregrad der Symptomatik nach primärer beziehungsweise sekundärer Infektion. Bei allen Patienten, die das Herz eines seropositiven Spenders erhielten, ergab sich eine höhere Inzidenz an CMV-Erkrankungen, als bei denen, die einen seronegativen Spender hatten. Nach der Transplantation eines Herzens von einem seropositiven Spender war jedoch bei unseren passiv immunisierten seronegativen Patienten die gleiche Inzidenz (27%) von CMV-Erkrankungen zu beobachten wie bei den Patienten mit natürlich erworbener Seropositivität. In der Prävalenz der koronaren Herzkrankheit ergab sich kein Unterschied zwischen Patienten mit und ohne CMV-Infektion oder Erkrankung. Demzufolge hängt das Auftreten einer CMV-Infektion und Erkrankung bei Anwendung des gegenwärtigen Schemas zur passiven Immunisierung weitgehend vom serologischen Status des Spenders ab.

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Copyright information

© MMV Medizin Verlag GmbH München 1993

Authors and Affiliations

  • A. H. M. M. Balk
    • 1
  • Karin Meeter
    • 1
  • B. Mochtar
    • 1
  • M. L. Simoons
    • 1
  • W. Weimar
    • 2
  • H. J. Metselaar
    • 2
  • Ph. H. Rothbarth
    • 3
  1. 1.ThoraxcenterHospital of the Erasmus University Rotterdam-DijkzigtRotterdamThe Netherlands
  2. 2.Dept. of Internal MedicineHospital of the Erasmus University Rotterdam-DijkzigtRotterdamThe Netherlands
  3. 3.Dept. of VirologyHospital of the Erasmus University Rotterdam-DijkzigtRotterdamThe Netherlands

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