We studied the effects of cytomegalovirus (CMV)
infection on 301 cardiac transplant recipients who were treated during the
cyclosporine era of immunosuppression (1980 to the present). These patients received varying combinations of
cyclosporine,
azathioprine,
prednisone,
rabbit antithymocyte globulin, and
OKT3 as their immunosuppressive therapy. Two hundred ten patients were free of CMV
infection (non-CMV group). During the same period CMV
infection developed in 91 patients, as manifested by a fourfold
IgG serologic titer rise, demonstration of
CMV inclusion bodies in tissue, or positive cultures for the virus (CMV group). The rate of graft rejection was significantly higher in the CMV group. Graft
atherosclerosis was significantly more severe in the CMV group as judged by angiographic criteria or by pathologic study. Patient survival rates were significantly lower in the CMV group. Death caused by graft
atherosclerosis was significantly more common among patients in the CMV group. Finally, the graft loss rate (from either death or retransplantation for
atherosclerosis) was significantly greater in the CMV group. These data demonstrate that CMV
infection in cardiac transplant recipients is associated with more frequent rejection, graft
atherosclerosis, and death.