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Eur J Cardiothorac Surg 1998;14:15-18
© 1998 Elsevier Science NL

Is routine post-operative surveillance for cytomegalovirus infection following heart transplantation necessary?¹

^a Department of Cardiological Sciences, St. George's Hospital, Tooting, London SW17 0QT, UK
^b Department of Cardiothoracic Surgery, St. George's Hospital, Tooting, London SW17 0QT, UK
^c Department of Medical Microbiology, St. George's Hospital, Tooting, London SW17 0QT, UK

Received 15 December 1997; received in revised form 2 March 1998; accepted 15 April 1998.

^* Corresponding author. Tel.: +44 181 725 3287.

Objective: Cytomegalovirus infection (CMV) is an important cause of morbidity and mortality following cardiac transplantation. The purpose of the present study was to ascertain whether routine post-operative screening for CMV infection influenced clinical management. Methods: Laboratory and case notes of 220 patients who received cardiac transplantation between November 1986 and October 1996 were reviewed. The range of follow-up was one to 120 (median 36) months. CMV surveillance involved blood tests for early antigen detection weekly for the first 6 post-operative weeks, fortnightly thereafter until the end of the third post-operative month and every 6 weeks to the end of the first post-operative year. Otherwise monitoring was performed if the patients had clinical symptoms suggestive of CMV infection. CMV sero-negative IgG recipients (R) of sero-positive IgG donor (D) organs and/or blood products received hyper-immune gammaglobulin for the first three post-operative 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 received ganciclovir therapy. The distribution of clinical CMV infection requiring 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 who were CMV antigen positive but who did not develop symptoms were not treated with ganciclovir and have remained well. Conclusion: Our results suggest that routine screening for CMV following cardiac transplantation is unnecessary. Surveillance did not result in the instigation of treatment for CMV unless there were associated clinical features of CMV infection.

Key Words: Cardiac transplantation • Cytomegalovirus infection