Combined antiviral and immunoglobulin therapy as prophylaxis against XXXX after heart transplantation.

@entity1 @entity2803 @entity1033 @entity55 @entity1902 @entity281 @entity1431 @entity4540 @entity221
BACKGROUND: @entity2803 is a frequent cause of @entity281 and morbidity after heart transplantation, especially in @entity1 treated with antilymphocytic drugs where the incidence may be as high as 50%. METHODS: To determine the efficacy of combined antiviral and intravenous immune globulin therapy for prevention of @entity2803 in transplant recipients receiving OKT3 and to compare two different antiviral drug regimens, we reviewed 115 transplant recipients from December 1988 to December 1993 who survived for more than 30 days. Of these, 29 received oral @entity1033 for 3 months (group A) and 86 received intravenous @entity4540 for 2 weeks followed by oral @entity1033 up to 3 months (group G); all received six infusions of 5% intravenous immune globulin over 2 months. All @entity1 had OKT3 for 10 to 14 days and triple-drug immunosuppression. RESULTS: @entity2803 ( @entity55 , @entity1902 , or @entity1431 with @entity221 ) occurred in 10% of @entity1 (12 of 115 @entity1 ) and was confirmed by positive culture, typical microscopic inclusions, or polymerase chain reaction. In 91 seropositive recipients, there was a trend to less @entity2803 in group G (3.0%, 2 of 67 @entity1 ) than in group A (12.5%, 3 of 24 @entity1 ) (p = 0.11), which was more apparent in recipients with seropositive donors where the incidence was reduced from 16.7% (group A) to 2.4% (group G; p = 0.08). In 24 seronegative recipients, @entity2803 incidence was higher overall and not significantly less in group G (26%, 5 of 19 @entity1 ) than in group A (40%, two of five @entity1 ) (p = Not significant). CONCLUSIONS: Prophylaxis with combined antiviral and immune globulin therapy produces a low (10%) incidence of @entity2803 in OKT3-treated heart transplant recipients. In seropositive recipients treated with combined therapy, @entity4540 may be more effective than @entity1033 . Larger trials and more aggressive prophylactic strategies are needed in seronegative @entity1 who receive hearts from seropositive donors.
