An Examination of Cytomegalovirus, Socioeconomic Status, Race, and Ethnicity on Outcomes after Haploidentical Hematopoietic Transplantation

Jeurkar, Chetan; Leiby, Benjamin E.; Banks, Joshua; Leader, Amy; Rudolph, Shannon; Mateja, Gina; Rashid, Shaik; Carabasi, Matthew; Filicko-O'Hara, Joanne; O'Hara, William; Wagner, John L.; Gergis, Usama; Flomenberg, Neal; Grosso, Dolores

doi:10.1016/j.jtct.2020.11.017

Cited by 4 publications

(1 citation statement)

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“…is that we analyzed a much larger cohort with a more comprehensive dataset. The importance of CMV prevention is highlighted by a recent study in a different transplant population of haploidentical hematopoietic cell transplant recipients, where CMV reactivation was noted to be the major driver of mortality ( 33 ). While it is likely that short-term mortality in CMV D+/R- DDKT recipients in our study may be directly related to CMV disease, the exact mechanisms underlying long-term patient and graft mortality remain unclear and may be attributable to the indirect effects of CMV infection.…”

Section: Discussionmentioning

confidence: 99%

Patient years lost due to cytomegalovirus serostatus mismatching in the scientific registry of transplant recipients

Abidi,

Schold,

Kaplan

et al. 2024

Front. Immunol.

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BackgroundThe cytomegalovirus (CMV) mismatch rate in deceased donor kidney transplant (DDKT) recipients in the US remains above 40%. Since CMV mismatching is common in DDKT recipients, the cumulative effects may be significant in the context of overall patient and graft survival. Our primary objective was to describe the short- and long-term risks associated with high-risk CMV donor positive/recipient negative (D+/R-) mismatching among DDKT recipients with the explicit goal of deriving a mathematical mismatching penalty.MethodsWe conducted a retrospective, secondary analysis of the Scientific Registry of Transplant Recipients (SRTR) database using donor-matched DDKT recipient pairs (N=105,608) transplanted between 2011-2022. All-cause mortality and graft failure hazard ratios were calculated from one year to ten years post-DDKT. All-cause graft failure included death events. Survival curves were calculated using the Kaplan-Meier estimation at 10 years post-DDKT and extrapolated to 20 years to provide the average graft days lost (aGDL) and average patient days lost (aPDL) due to CMV D+/R- serostatus mismatching. We also performed an age-based stratification analysis to compare the relative risk of CMV D+ mismatching by age.ResultsAmong 31,518 CMV D+/R- recipients, at 1 year post-DDKT, the relative risk of death increased by 29% (p<0.001), and graft failure increased by 17% (p<0.001) as compared to matched CMV D+/R+ group (N=31,518). Age stratification demonstrated a significant increase in the risk associated with CMV mismatching in patients 40 years of age and greater. The aGDL per patient due to mismatching was 125 days and the aPDL per patient was 100 days.ConclusionThe risks of CMV D+/R- mismatching are seen both at 1 year post-DDKT period and accumulated throughout the lifespan of the patient, with the average CMV D+/R- recipient losing more than three months of post-DDKT survival time. CMV D+/R- mismatching poses a more significant risk and a greater health burden than previously reported, thus obviating the need for better preventive strategies including CMV serodirected organ allocation to prolong lifespans and graft survival in high-risk patients.

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Section: Discussionmentioning

confidence: 99%