What is the most appropriate opportunistic infection prophylaxis for a heart transplant patient with donor negative CMV serology?

The most appropriate opportunistic infection prophylaxis for a heart transplant patient with donor negative cytomegalovirus (CMV) serology is sulfamethoxazole/trimethoprim with acyclovir.

In the context of heart transplantation, patients are at increased risk for opportunistic infections due to immunosuppressive therapy. Prophylaxis is crucial, particularly against infections such as pneumocystis pneumonia (PCP) and viral infections like CMV.

Given the donor negative CMV status, the recipient is not at high risk for CMV disease, so the focus shifts towards preventing other opportunistic infections. Sulfamethoxazole/trimethoprim is effective for preventing PCP, which is a common concern in solid organ transplant recipients. Acyclovir, on the other hand, is used to prevent herpes simplex virus (HSV) and varicella-zoster virus (VZV), which can also pose a risk in this population.

The combination of sulfamethoxazole/trimethoprim with acyclovir ensures that both bacterial and viral opportunistic infections are addressed effectively for the patient, making it a comprehensive prophylactic strategy. The choice of this particular regimen aligns with standard practice guidelines for heart transplant