Preemptive therapy for the prevention of cytomegalovirus disease following heart transplantation directed by PP65 antigenemia

CYTOMEGALOVIRUS (CMV) INFECTION after heart transplantation produces significant morbidity and mortality. The effects of the virus can be divided into two categories: direct causation of infectious disease syndromes and an indirect role in accelerated coronary atherosclerosis in the allograft. Most transplant groups have adopted different prophylactic approaches; these strategies in heart transplantation remain controversial. Because of the impact of CMV on transplant patients, an aggressive and prompt diagnostic approach to the infection is mandatory. Recent advances in viral diagnostic techniques have enabled the early diagnosis of CMV infection. Of all the diagnostic tests available for CMV, viremia is the most accessible and useful. There are two approaches available to assess viremia (antigenemia assay and quantitative polymerase chain reaction): both provide quantitative information that delineates viral load, displays good sensitivity and specificity for the diagnosis, and usually demonstrates viremia several days prior to the onset of clinical symptoms. Many groups monitor their patients for preclinical viremia by these techniques, and then initiate preemptive treatment for patients shown to be at risk for clinical disease on this basis. We present our experience with preemptive therapy (PT) with gancyclovir for the prevention of CMV disease following heart transplantation directed by pp65 antigenemia.