Morbidity of Cytomegalovirus Infection in Recipients of Heart or Heart-Lung Transplants Who Received Cyclosporine

Abstract

Forty-four heart and five heart-lung transplant recipients with cytomegalovirus (CMV) infection were investigated for risk factors associated with symptomatic CMV infection (17 patients) and CMV pneumonia (eight patients). Symptomatic infection was associated with primary rather than reactivated infection (P <.005), younger age (P <.005), heartlung transplantation (P <.001), and significant rises in titer of antibody to the early antigen of Epstein-Barr virus (P< .001). Among recipients of heart transplants, patients with cardiomyopathy more often had symptomatic disease due to CMV (P<.05). CMV pneumonia was associated with heart-lung transplantation and, in patients with primary CMV infection, earlier positive cultures for CMV after transplantation (P<.02). CMV viremia was found in all patients with symptomatic infection, including the eight patients with CMV pneumonia, and the frequency of positive buffy coat cultures for CMV was significantly higher in patients with symptoms than in patients without symptoms (P < .001). Neither symptomatic CMV infection nor CMV pneumonia was significantly associated with the use of antithymocyte globulin, restricted to therapy for rejection, and the use of high doses of acyclovir in 11 patients had no demonstrable impact on CMV culture positivity.