Early Adjunctive Treatment with Human Cytomegaly Virus Immunoglobulin Increased CMV-Free Survival after Heart Transplantation

Objectives: There is still an ongoing discussion whether a prophylactic or a preemptive therapy against cytomegalovirus (CMV) is superior to reduce the incidence of CMV viremia, acute rejections (AR) or cardiac allograft vasculopathy (CAV) after heart transplantation (HTx). Thus, we evaluated different CMV treatment strategies in this setting.

Methods: HTx patients (n = 56) were retrospectively studied from January 1, 2010, to January 31, 2016. Study end points were the CMV-free survival viremia, AR, and CAV. The average follow-up was 4.15 years (355 days up to 7.5 years). Patients were classified into 3 groups according to their received CMV therapy: preemptive therapy (n = 19), prophylactic drug monotherapy (either valganciclovir for 3 months or early single dose of 1 mg/kg/BW of CMV immunoglobulin, CMVIG, 2 weeks post-HTx, n = 18) or prophylactic double drug therapy (valganciclovir for 3 months plus early single dose of CMVIG, n = 19). For statistical analysis X², X²-log-rank and T-tests were used.

Results: The median patient survival was not significant different among the study groups: preemptive group 2,243 days, prophylactic monotherapy 2,417 days, and prophylactic double therapy 2,410 days, respectively. However, the median CMV-viremia-free survival was different among the groups: 1,817 days in the prophylactic double group, 1,459 days in the prophylactic mono group and 1,482 in the preemptive group (p = 0.52). A subanalysis of patients with high risk for CMV infection (donor positive and recipient negative CMV status) the CMV-free survival was significantly higher when patients received double prophylaxis therapy compared to the other two groups (p < 0.01). Either the incidence of AR or of CAV was not significantly influenced by the choice of CMV treatment regimen. The antiviral medication was discontinued in 10.5% preemptive group, 38.9% prophylactic mono group, and 31.6% prophylactic double group, respectively.

Conclusions: Our study results suggest that early therapy with CMVIG as adjunct to antiviral treatment could prolong CMV-free survival in patients with CMV risk of infection. If a repetitive CMVIG dosing post-HTx will further reduce CMV infection needs to be explored in the future.