Wiener Klinische Wochenschrift

, Volume 116, Issue 15–16, pp 542–551

Können CMV-Infekte nach Herztransplantation durch dreimonatige antivirale Prophylaxe reduziert werden? 7 Jahre Erfahrung mit Ganciclovir

  • Herwig Antretter
  • Daniel Höfer
  • Herbert Hangler
  • Clara Larcher
  • Gerhard Pölzl
  • Christoph Hörmann
  • Josef Margreiter
  • Raimund Margreiter
  • Günther Laufer
  • Hugo Bonatti
Originalarbeit

Zusammenfassung

Hintergrund und Fragestellung

In der frühen Phase nach Herztransplantation (HTX), der Zeit intensivster Immunsuppression, haben Patienten ein hohes Infektionsrisiko. Diese retrospektive Kohortenstudie evaluiert die Wirksamkeit einer dreimonatigen antiviralen Cytomegalievirus (CMV)-Prophylaxe.

Patienten und Methodik

133 Patienten (Gruppe II: HTX 1997 — April 2003) erhielten eine dreimonatige kombiniert intravenös-orale CMV-Prophylaxe (Ganciclovir-Cymevene®) und wurden mit einer historischen Gruppe I (40 Patienten, HTX 1995-1996; CMV-Prophylaxe: CMV-Hyperimmunglobulin [Cytotect®] im 1. postoperativen Monat; Aciclovir [Zovirax®] oral über 6 Monate) verglichen.

Demographische Daten der Spender und Ernpfänqer beider Gruppen zeigten keine relevanten Unterschiede (ausgenommen cardiale Grunderkrankungen; p=0,016). In beiden Gruppen wurde ein identes immunsuppressives Regime verwendet.

Ergebnisse

In Gruppe II war die Mortalität hochsignifikant geringer (GI: 37,5%, GIl: 9,8%, p<0,001), das Einjahresüberleben (p=0,001) und das Gesamtüberleben (p 0,001) hochsignifikant besser als in Gruppe I. Patienten der Gruppe II hatten hochsignifikant weniger höhergradige, therapiewürdige Abstoßungen (≥ Grad II nach ISHLT) (p<0,001).

In Gruppe II fanden sich signifikant weniger positive CMV-Bluttests (p=0,005) und CMV-Infektionen (25,6% vs. 47,5% in GI; p=0,008), diese traten hochsignifikant später nach der HTX auf als in Gruppe I (GI: im Mittel 5,8 Wochen nach HTX, GII: 23,6 Wochen, p<0,001).

Folgerungen

Unter Ganciclovirprophylaxe war die Inzidenz der CMV-Infekte nicht nur signifikant reduziert, sie wurden zudem in eine spätere Phase nach HTX, in der Patienten immunologisch wiederum kompetenter sind, verschoben. Höhergradige Abstoßungen waren in der Ganciclovirgruppe hochsignifikant seltener, die zudem ein verbessertes Einjahres- und Langzeitüberleben aufweist.

Schlüsselwörter

Cytomegalovirus Herztransplantation antivirale Prophylaxe 

Is it possible to reduce CMV-infections after heart transplantation with a three-month antiviral prophylaxis? 7 years experience with Ganciclovir

Summary

Background

In the early phase after heart transplantation (HTX) patients are at high risk for infection because of intensified immunosuppression. This retrospective study evaluates the efficacy of a three-month antiviral cytomegalovirus (CMV) prophylaxis.

Patients and methods

133 patients received a three-month combined intravenous and oral CMV prophylaxis with Ganciclovir (Cymevene®) after HTX between 1997 and April 2003 (group II). They were compared to a historical group consisting of 40 patients, who had undergone HTX between 1995 and 1996 (group I; CMV-prophylaxis: hyperimmune globuline (Cytotect®) for the first post-operative month in combination with orally administered aciclovir (Zovirax®) for 6 months).

Demographic data of organ recipients and donors in both groups were comparable, except for underlying cardiac diseases (p=0.016). All patients had identical postoperative immunosuppressive regimes.

Results

Group II had a significantly lower mortality rate (GI: 37.5%, GII: 9.8%; p<0.001); one year survival (p=0.001) and overall survival (p=0.001) were significantly better than in group I. Patients of group II had fewer rejection episodes ≥ grade II ISHLT requiring treatment (p<0.001).

Group II presented significantly fewer positive CMV blood samples (p=0.005) and CMV infections (26% versus 47,5% in GI; p=0.008), and a later onset of infections after HTX than group I (group I with a mean interval of 5.8 weeks after HTX, group II: 24.8 weeks after HTX; p<0.001).

Conclusion

Incidence of CMV infection was significantly lowered under ganciclovir prophylaxis, infections occurred at a later time point after HTX, when patients were immunologically more competent. The proportion of higher grade rejection episodes was markedly reduced and survival was improved.

Key words

Cytomegalovirus heart transplantation antiviral prophylaxis 

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Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Herwig Antretter
    • 1
  • Daniel Höfer
    • 1
  • Herbert Hangler
    • 1
  • Clara Larcher
    • 2
  • Gerhard Pölzl
    • 3
  • Christoph Hörmann
    • 4
  • Josef Margreiter
    • 4
  • Raimund Margreiter
    • 5
  • Günther Laufer
    • 1
  • Hugo Bonatti
    • 5
  1. 1.Klinische Abteilung für HerzchirurgieUniversitätsklinik für Chirurgie, Medizinische Fakultät der UniversitätInnsbruckÖsterreich
  2. 2.Institut für HygieneMedizinische Fakultät der Universität InnsbruckInnsbruckÖsterreich
  3. 3.Klinische Abteilung für KardiologieUniversitätsklinik für Innere Medizin, Medizinische Fakultät der Universität InnsbruckInnsbruckÖsterreich
  4. 4.Klinische Abteilung für Anästhesie und IntensivmedizinMedizinische Fakultät der Universität InnsbruckInnsbruckÖsterreich
  5. 5.Klinische Abteilung für TransplantationschirurgieMedizinische Fakultät der Universität InnsbruckInnsbruckÖsterreich

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