Diminished impact of cytomegalovirus infection on graft vasculopathy development in the antiviral prophylaxis era - a retrospective study

Abstract

Evidence concerning an association between cytomegalovirus (CMV) infection and accelerated cardiac allograft vasculopathy (CAV) is inconclusive. Data were analyzed retrospectively from 297 consecutive heart transplants between 1.1.2002 and 31.12.2012. Patients ≤18 years of age, survival, and follow-up ≤1-year post-transplant and patients with early CAV were excluded. CMV-infection was diagnosed and monitored closely in the first year. CAV was diagnosed by coronary angiography via left heart catheterization, and results were categorized according to the International Society of Heart and Lung Transplantation (ISHLT) scoring system. Risk factors for CAV were tested in a multivariable model. Median follow-up was 7.5 years (IQR: 5.6-10.3). CMV infection in the first year after transplantation occurred in 26% of patients (n = 78), CMV disease in 5% (n = 15). CAV ≥1 ISHLT was detected in 36% (n = 108). Incidence of CAV >1 ISHLT and severity of CAV increased over time. No statistically significant association between CMV infection and disease within the first year and risk of CAV after 1-year post-HTx was detected in the univariate (P = 0.16) and multivariable [hazard ratio (HR), 1.36; confidence interval (CI), 0.89-2.07; P = 0.16] Cox regression. In the multivariable Cox regression, donor age (HR, 1.04; 95% CI, 1.02-1.06; P < 0.01) and acute cellular rejection (ACR) ≥2R in the first year after HTx (HR, 1.77; 95% CI, 1.06-2.95; P = 0.03) were independent risk factors for CAV development. In our cohort, CMV infection and disease in the first year after transplantation did not significantly influence the risk of CAV in the long-term follow-up.

Cytomegalovirus infection and allograft rejection among pediatric heart transplant recipients in the era of valganciclovir prophylaxis

“…That said, consistent with a number of prior adult studies, we noted no associations between CMV risk status, overall CAV, and survival following HTx 31,32 . In addition, despite reports of decreased allograft survival among other pediatric SOT populations (particularly renal transplant recipients) associated with CMV replication, CMV HR status was not associated with overall risk of rejection or graft survival in our cohort 25,33 .…”

Impact of valganciclovir prophylaxis duration on cytomegalovirus disease in high‐risk donor seropositive/recipient seronegative heart transplant recipients

“…Additionally, the presence of confounding by indication was assessed by inverse propensity weighting analysis. The observed overall incidence of proven/probable CMV disease in our D+R− HTR cohort, 5.2% (3/58) at 6 months and 17.2% (10/58) at 1 year, was similar to previously published cohorts receiving 3 or 6 months of prophylaxis and provides some reassurance of the generalizability of results to other heart transplant populations (10.5% [10/95] pooled 6‐month CMV disease incidence, 21.2% [41/193] pooled 1‐year CMV disease incidence, studies summarized in Table S2). We acknowledge that the size of our cohort limited the difference in CMV disease that could be detected between the 3‐month vs 6‐month groups; however, the number of patients in this study was still relatively large in comparison to prior studies focused on D+R− HTR, and we did not observe even a trend toward benefit of a longer duration of prophylaxis.…”

Absolute Lymphocyte Count as a Marker for Cytomegalovirus Infection After Heart Transplantation

“…[5][6][7] The impact of CMV infection on accelerated cardiac allograft vasculopathy is described in some studies, but contradicted in others. 8,9 CMV remains one of the most critical pathogens after heart transplantation, and various measures are taken to prevent and treat CMV infection and disease. As of late, a correlation between reduced lymphocyte count and CMV infection has been suggested, highlighting the potential for absolute lymphocyte count (ALC) to serve as a simple and inexpensive tool to predict CMV infection after solid organ transplantation (SOT).…”