CMV infection in the new millenium

Background: Cytomegalovirus (CMV) is a significant cause of morbidity in heart transplantation. New diagnostic tools (CMV-PCR) and treatment options (ganciclovir GCV) have been adopted. The aim of this analysis was to evaluate the incidence of CMV infection (Inf)/disease (Dis) between 2002–2008 in comparison with earlier eras. Methods: We studied 823 heart transplant recipients (1984–2008). Study population was categorized into 4 groups (D-/R-, D-/R+, D+/R–, D+/R+) and 4 eras (1984–91, 92–96, 97–02, 02–08). CMV Inf was defined as positive IgM serology (≤1990), positive EA (91–02) or increase of CMV-PCR ≥600cps/ml (≥2002). Dis was defined as Inf with clinical symptoms. All patients received CMVIG and CMV-high risk patients (D+/R–) received prophylaxis with GCV for 3 weeks (97–01) and val-GCV for 3 months (≥02). The incidence of CMV Inf and CMV Dis was analysed. Results: Overall Inf remained similar during the different eras (12 months: 35% vs. 34 vs. 30 vs. 34%, p=ns). Dis decreased significantly (12 months: 16% vs. 21 vs. 10 vs. 4%, p<0.0001). Inf and Dis decreased in the high risk (D+/R–) group during the eras (Inf: 12 months: 53% vs. 49 vs. 39 vs. 29%, p: 0.09; Dis: 12 months: 24% vs. 31 vs. 22 vs. 0%, p: 0.002). Between 02–08, Inf was highest in D+/R+ patients (12 months: 55% vs. 3 (–/–), 30 (–/+) and 29 (+/–)%, p<0.0001), however there was no difference in Dis (12 months: 8 (+/+) vs. 0 (–/–), 3 (–/+) and 0 (+/–)%) Conclusion: Today CMV Inf is diagnosed and therapy can be started earlier. This approach can reduce morbidity and mortality. However, CMV +/+ patients might benefit from CMV prophylaxis with GCV.