Infections Due to Herpesviruses in Cardiac Transplant Recipients: Role of the Donor Heart and Immunosuppressive Therapy

The role of the donor heart and immunosuppressive therapy on infection due to herpesviruses in 74 cardiac transplant recipients (CTRs) was determined. When cellular blood products from donors seronegative for antibody to cytomegalovirus (anti-CMV) were used, all primary CMV infections were attributable to transmission from donor heart. None of eight CTRs negative for anti-CMV before transplant and who received an anti-CMV donor heart and anti-CMV blood products developed CMV infection compared to one (20%) of five who received unscreened blood. A change from high-dosage antithymocyte globulin, azothioprine, and prednisone (ATO regimen) to low-dosage antithymocyte globulin, cyclosporin A, and prednisone (CsA regimen) significantly decreased the severity and prevalence of lesions due to herpes simplex virus and the duration of CMV shedding in patients with recurrent CMV infection. CTRs with recurrent CMV infection treated with the ATO regimen had significantly more fever, required more parenteral antibiotics, and were more likely to be infected with opportunistic pathogens than were CsA-treated patients.