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  • Title: Should heart-lung transplant donors and recipients be matched according to cytomegalovirus serologic status?
    Author: Novick RJ, Menkis AH, McKenzie FN, Reid KR, Ahmad D.
    Journal: J Heart Transplant; 1990; 9(6):699-706. PubMed ID: 2177496.
    Abstract:
    Cytomegalovirus (CMV) infection is a major cause of morbidity and mortality after heart-lung transplantation. Primary CMV infections in previously seronegative recipients are more severe than reactivated or reinfections in seropositive patients, and this has led to a policy of obligatory donor-recipient CMV matching in several centers performing heart-lung transplantation. Of our 13 heart-lung transplants, three were done in CMV-seronegative patients who received CMV-positive grafts. The first patient did not seroconvert and exhibited no evidence of CMV infection despite close follow-up extending to almost 2 years. In the second patient, who required augmented immunosuppression because of recurrent lung rejection early postoperatively, fulminating CMV pneumonitis developed, which was ultimately controlled with ganciclovir and high-dose CMV immune globulin. As an outpatient, she is currently receiving ganciclovir maintenance therapy. The third patient, who received high-dose CMV immune globulin prophylaxis, had CMV isolated from her bronchoalveolar lavage fluid, as well as from urine, but remains clinically well 5 months after receiving her transplant. We conclude that the matching of donors and recipients for CMV serologic status is desirable, but not essential, before heart-lung transplantation. CMV immune globulin prophylaxis may be effective in preventing clinical CMV disease in patients receiving a CMV-mismatched graft, and severe CMV pneumonitis may be effectively treated by a combination of ganciclovir and high-dose CMV immune globulin therapy.
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