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

Mabilangan, Curtis; Preiksaitis, Jutta K.; Cervera, Carlos

doi:10.1111/tid.12964

Cited by 16 publications

(6 citation statements)

References 22 publications

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“…Previous studies have suggested that donor and recipient cytomegalovirus mismatch increases the risk of mortality in LTx patients. 28,29 Similar results were reported in our model in which cytomegalovirus mismatch was found to be a significant risk factor. Similar pattern was also seen when considering ECMO use.…”

Section: Discussionsupporting

confidence: 87%

Lung Transplantation Advanced Prediction Tool: Determining Recipient’s Outcome for a Certain Donor

et al. 2022

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L ung transplantation (LTx) faces a suboptimal organ allocation scheme, with long waiting times and high waiting list mortality for transplant candidates. Although the lung allocation score (LAS) stratifies recipient risk and contributes to lowering waiting time, mortality remains 15% for adult and 22% for pediatric patients awaiting LTx. 1 On the other hand, only 20% of all multiorgan donors are utilized for LTx in the United States, compared with 50% in European countries. 2,3 An important factor contributing to the apparent shortage of organs in the United States is the usage of nonstandardized and often stringent donor selection criteria: Over 15 different characteristics that vary between centers are considered while selecting donors. 4 The role of each of these characteristics and their combined effect is largely unknown. Other solid organ transplant groups have successfully devised comprehensive donor risk stratification systems based on the combined impact of these characteristics to standardize their matching process. 5 For example, the kidney donor profile index, adapted by the United Network for Organ Sharing (UNOS) in 2014, resulted in increased utilization of organs, and

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Section: Discussionsupporting

confidence: 87%

Lung Transplantation Advanced Prediction Tool: Determining Recipient’s Outcome for a Certain Donor

et al. 2022

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“…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 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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Purpose This study aimed to describe the cytomegalovirus (CMV) infection rate, rehospitalizations, and comorbidities following allogeneic hematopoietic stem cell transplantation (allo-HSCT) and solid organ transplantation (SOT). Methods Patients who received allo-HSCT or SOT in 01/07/2015–30/06/2018 were identified using anonymized German claims data. The transplantation-related hospital admission date was defined as the index date, and patients were followed for up to 12 months (or death, first event relevant). The frequency of CMV infections (confirmed outpatient/inpatient diagnoses, ICD-10-GM codes: B25.-/B27.1) and the rate, number, and duration of all-cause rehospitalizations in the follow-up period were evaluated. Results A total of 226 allo-HSCT and 250 SOT patients were identified (mean age 52.8 years, 38.9% female). During the 12 months after transplantation, 29.2% of allo-HSCT patients and 16.8% of SOT patients received a CMV diagnosis. The majority of these diagnoses were given during the initial hospitalization or within the following 3 months. Across transplantation types, CMV patients had more hospital readmission days per patient-year (allo-HSCT 93.3 vs. 49.4, p = 0.001; SOT 42.0 vs. 20.7, p = 0.005), with a longer mean duration of readmissions (allo-HSCT 22.4 vs. 15.4 days, p < 0.001; SOT 11.6 vs. 7.5 days, p = 0.003). Comorbidity burden in transplantation patients was substantial, with several diagnoses being significantly more common among patients with CMV vs. non-CMV. One-year mortality did not differ significantly between patients with/without CMV. Conclusion Burden of transplant recipients with CMV in terms of rehospitalizations and comorbidities is substantial, highlighting the need for improved CMV prevention and treatment.

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“…9,10 Native lung disease was chosen as it demonstrates consistent associations with post-lung transplant outcomes. 11 In addition, pre-transplant CMV serostatus matching has been associated with lung transplant patient survival variable 12 and, therefore, included as an additional variable. For illustration purposes, we provide Kaplan−Meier survival curves.…”

Section: Discussionmentioning

confidence: 99%

Risk assessment of chronic lung allograft dysfunction phenotypes: Validation and proposed refinement of the 2019 International Society for Heart and Lung Transplantation classification system

Levy

Huszti

Renaud-Picard

et al. 2020

The Journal of Heart and Lung Transplantation

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BACKGROUND: Chronic lung allograft dysfunction (CLAD) is a heterogeneous condition. Characterization of CLAD phenotypes is essential to enhance the understanding of pathogenesis and guide new therapies. The study objective was to validate the new International Society for Heart and Lung Transplantation (ISHLT) CLAD classification system and further explore patients who do not fall into the defined CLAD sub-categories. METHODS: We performed a single-center, retrospective cohort study of adult, first, bilateral lung transplants performed from 2010 to 2015. Patients with CLAD were classified on the basis of the 2019 ISHLT consensus document. CLAD phenotypes and other potential predictors of survival after CLAD onset were assessed using Kaplan−Meier and Cox proportional hazards models. RESULTS: Among the 174 subjects with CLAD, 104 (59.8%) had bronchiolitis obliterans syndrome (BOS), 16 (9.2%) restrictive allograft syndrome (RAS), 9 (5.2%) mixed, and 19 (10.9%) undefined phenotype. A total of 26 patients (14.9%) did not match any of these 4 categories and remained unclassified. Allograft survival post-CLAD onset was longer for patients with BOS (median, 500 days) than patients with RAS (median, 372 days) or mixed (median, 328 days). The 45 patients (26.8%) with undefined/unclassified phenotype were combined and recategorized on the basis of the presence or absence of characteristic RAS-like opacities on chest imaging; those with RAS-like opacities had significantly worse allograft survival than patients with BOS (hazard ratio, 2.14; 95% confidence interval, 1.17−3.93; p = 0.014) and similar survival to RAS or mixed phenotype.

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

Abstract: Our review of the impact of CMV managed differently across eras suggests in lung transplantation there is no independent influence of D/R CMV serostatus on 10-year survival.

Cited by 16 publications

References 22 publications

Lung Transplantation Advanced Prediction Tool: Determining Recipient’s Outcome for a Certain Donor

Lung Transplantation Advanced Prediction Tool: Determining Recipient’s Outcome for a Certain Donor

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

Risk assessment of chronic lung allograft dysfunction phenotypes: Validation and proposed refinement of the 2019 International Society for Heart and Lung Transplantation classification system

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