Impact of donor and recipient cytomegalovirus serology on long‐term survival of heart transplant recipients

Abstract

Background: Some studies have shown that pre-transplant cytomegalovirus (CMV) serostatus is associated with heart transplant patient survival while others have not.We analyzed the relationship between pre-transplant donor/recipient CMV serostatus and long-term mortality in a retrospective cohort of heart transplant recipients at our center. Methods: Adult (Age >17 years) heart recipients transplanted between July 1985-December 2015 were analyzed. Variables included age, sex, pre-transplant donor (D)/recipient (R) serostatus [D−/R−, D−/R+, D+/R+, D+/R−], CMV infection within 2 years of transplant and transplant eras divided by changes in CMV prevention strategies: Era Survival analysis and Cox regression were performed at 10 years. Results: A total of 620 heart transplants were included in our analysis; 20% were CMV mismatched pre-transplant. Thirty-eight percent of patients were infected with CMV within the first two post-transplant years. Survival analysis showed D/R CMV serostatus did not significantly impact survival of heart recipients at 10 years (P = 0.11). Survival was significantly different across eras for D−/R+, D+/R+, and D+/ R+ (P = 0.043) but not D−/R− patients (P = 0.8). Cox regression revealed that patients transplanted in the valganciclovir era have an estimated 29% reduced risk of death (P = 0.047) compared to patients transplanted in the pre-ganciclovir era after controlling for age at transplantation, D/R CMV serostatus and CMV infection. Conclusion: Our review of the impact of CMV managed differently across eras suggests in heart transplantation there is no influence of D/R CMV serostatus on 10 year survival. K E Y W O R D S CMV prophylaxis, CMV serology, CMV serostatus, cytomegalovirus, heart transplantation, survival S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Mabilangan C, Preiksaitis JK, Cervera C; on behalf of the University of Alberta Cardiothoracic Transplant Group. Impact of donor and recipient cytomegalovirus serology on long-term survival of heart transplant recipients. Transpl Infect Dis. 2019;21:e13015.

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

“…While a number of adult studies have evaluated the role of CMV infection on CAV and graft rejection among HTx recipients, few studies have explored the impact of CMV risk status on infection, recurrence, and rejection in the setting of prophylactic VGC among children 10,23,24 . While we observed no difference in overall rejection, CAV or survival among CMV risk‐stratified children, time to first rejection episode was significantly shorter among HR (D + R−) HTx recipients as compared to IR (R+) and LR (D−R−) recipients, despite 6 months of VGC prophylaxis.…”

Epidemiology, management, and burden of cytomegalovirus in solid organ transplant recipients in selected countries outside of Europe and North America: A systematic review

“…Across the selected countries, most studies reported rates of CMV infection (ranging from 5.2% to 63.2% within 1 year posttransplant) and CMV disease (up to 19%) (Figure S4), which were consistent with those found in Europe and North America where reported rates ranged respectively, between 7.5% and 65.4% (31 studies) 61–91 and between 0.9% and 23.4% (22 studies) 62–65,68–71,76,79–83,87,89–90,92–96 . In this review, a trend toward lower rates of CMV infection was observed in kidney and liver recipients treated with ganciclovir or valganciclovir as CMV prophylaxis (5.2%–20.6%, n = 5 studies) compared to those only managed with preemptive monitoring (from 25.7% to 50.2%, n = 11 studies).…”

Cytomegalovirus infection and rehospitalization rates after allogeneic hematopoietic stem cell and solid organ transplantation: a retrospective cohort study using German claims data

“…Several studies reported that donor and/or recipient CMV serology alone was associated with a higher risk of mortality among HSCT [ 38 , 39 ] and SOT patients [ 31 , 40 , 41 ]. On the other hand, Mabilangan et al [ 42 , 43 ] found no association between donor/recipient CMV serology and 10 years mortality among heart or lung transplant recipients. One potential explanation for the similar survival rates of CMV and non-CMV patients in our study may be the limited follow-up time of 1 year, which is comparatively shorter than other analyses of survival which reported outcomes based on extended follow-up periods of 5 years or longer [ 34 – 36 , 39 , 41 ].…”