Cytomegalovirus infections in heart transplant recipients: Relationship to immunosuppression

M. R. Constanzo-Nordin, L. J. Swinnen, S. G. Fisher, E. J. O'Sullivan, R. Pifarre, A. L. Heroux, G. M. Mullen, M. R. Johnson

Research output: Contribution to journalArticle

Abstract

To determine the relationsbip of cytomegalovirus infections (CMVI) to immunosuppression in heart transplants, we retrospectively compared demographic and clinical variables in 154 consecutive heart transplant patients. Forty-one CMVI were compared; of these, 30 (73%) were identified in tissue, and nine (22%) were identified by blood or urine culture. Twenty (49%) of the CMVI were self-limited, and 21 (51%) were progressive, requiring treatment. When comparing patients with and without CMVI, demographic variables, mean preexisting heart disease, cyclosporine level, cumulative corticosteroid dose, and the use of anti-T-cell antibodies were examined. Only the use of OKT3 was significantly associated with the subsequent development of CMVI. Although CMVI subsequently developed in 30 of 79 (38%) patients who had received OKT3, CMVI developed in only 11 of 75 (15%) patients who had not received OKT3 (p = 0.01). Furthermore, the incidence of CMVI increased with increasing total OKT3 dose (none, 11 of 64 [17%]; ≤75 mg, 23 of 66 [35%]; >75 mg, 6 of 14 [43%]; p = 0.01). Logistic regression showed that the only two variables predictive of CMVI were the use of OKT3 (p = 0.0023) and ischemic rather than idiopathic heart disease before transplantation (p = 0.0098). Rejection rates, incidence of allograft vasculopathy, and 1-year actuarial survival were not influenced by previous CMVI. Pneumocystis carinii pneumonia occurred more frequently in patients with CMVI than in those without (13 of 41 [32%] patients versus 3/113 [3%] patients; p < 0.001). No correlation existed between CMVI and lymphoproliferative disorder (p = 0.84). We conclude that the risk of CMVI after heart transplantation is significantly related to the use and total dose of OKT3.

Original languageEnglish (US)
Pages (from-to)837-846
Number of pages10
JournalJournal of Heart and Lung Transplantation
Volume11
Issue number5
StatePublished - Jan 1 1992
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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    Constanzo-Nordin, M. R., Swinnen, L. J., Fisher, S. G., O'Sullivan, E. J., Pifarre, R., Heroux, A. L., Mullen, G. M., & Johnson, M. R. (1992). Cytomegalovirus infections in heart transplant recipients: Relationship to immunosuppression. Journal of Heart and Lung Transplantation, 11(5), 837-846.