Page 34 - Heart Transplant Protocol

Heart Function Service: Heart Transplant Protocols

 Valganciclovir 60 mg/ ml may be compounded at CMC pharmacy. The suspension is stable for
35 days.
 Administering Valganciclovir with food promotes absorption.
 Use chemotherapy precautions when administering IV Ganciclovir.
Monitoring:
1. CMV serology, and CMV PCR will be obtained at time of heart transplant from both donor and
recipient to assess risk.
2. For CMV R -, obtain CMV IgG and IgM in addition to CMV PCR until seroconversion occurs.
3. For CMV R+, order CMV PCR.
4. CMV surveillance schedule as follows post heart transplantation:
 2 weeks
 1 month
 2 months
 3 months
 6 months
 Every month from 6- 12 months
 Every 3 months after 12 months post-transplant until patient seroconversion
occurs.
 Once CMV seroconversion occurs following 12 months from transplant, only
obtain CMV PCR as clinically warranted.

 Cytomegalovirus (CMV) is a ubiquitous virus, which commonly infects immunosuppressed
patients. If not rapidly diagnosed and treated, the virus can cause retinitis and fatal hepatitis
or pneumonitis. CMV antibody negative patients who receive organs from CMV seropositive
donors are at a high risk for CMV disease.
 CMV is suspected whenever a patient has persistent fevers, or flu-like illness (myalgia,
arthralgia) accompanied by leukopenia, neutropenia, lymphopenia or a dropping platelet
count (CMV syndrome).
 CMV work-up includes a CMV PCR and/or CMV Antigenemia.
 All patients with CMV infection should receive an eye exam from an ophthalmologist to check
for CMV retinitis.
 If pneumonitis is suspected, a broncho-alveolar lavage should be performed and cells stained
for CMV. If the results are equivocal or negative, an open-lung biopsy may need to be
performed.
 If CMV is strongly suspected, or if a positive culture is obtained, then treatment will be guided
in consultation with Infectious Disease physician.
 The dose of IV Ganciclovir is 5 mg/kg. The dosing frequency is dependent upon the
Schwartz GFR:

Updated November 9, 2017 34