부산대학교 도서관

Introduction:CMV mismatch (donor positive, recipient negative CMV serology) has been observed to increase the development of CMV infection (defined as clinically symptomatic with detected viremia) after heart transplantation. There are many prophylactic regimens using valganciclovir in these patients. Despite having this prophylactic antibiotic, the natural history of CMV mismatch and the development of CMV infection is not clear.Methods:Between 2010 and 2014 we assessed 96 heart transplant patients who had CMV mismatch on serology (D+R-). These patients were compared to patients who were donor and recipient positive (D+R+, n=197), CMV recipient only positive (D-R+, n=92), or na?ve donor and recipients (D-R-, n=56). Our usual prophylaxis for CMV mismatch is 1 year of valganciclovir therapy and for positive donors and recipients was 6 months of valganciclovir therapy. CMV negative donor/recipient pairs received acyclovir for 6 months.Results:Patients who had CMV mismatch (D+R-) had significantly less 2-year freedom from CMV infection after heart transplantation compared to the other 3 groups despite longer prophylactic antibiotic therapy. There was no significant difference in subsequent 2-year freedom from CMV infection in CMV mismatch patients that did (n=42) and did not (n=54) receive a PSI in the first-year post-transplant. (See tables)Conclusions:The natural history of our patients with CMV mismatch (D+R-) suggests that the risk for CMV infection remains high even after a 1-year prophylactic period. The addition of a first-year PSI for CMV mismatch patients did not appear to offer protection from CMV infection.