Incidence and Severity of Cytomegalovirus Infection in Seropositive Heart Transplant Recipients

Gardiner, Bradley J.; Bailey, Jessica P; Morgan, Beth A; Percival, Mia; Warner, Victoria; Lee, S.J.; Morrissey, Orla; Peleg, Anton Y.; Taylor, Andrew J.

doi:10.1016/j.healun.2022.01.684

Cited by 2 publications

(5 citation statements)

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“…In this diverse cohort of 563 CMV R+ HT recipients from 6 high‐volume US centers, PET was associated with a significantly increased risk for both CMV infection, and CMV‐related hospitalization. These results build upon those of a recent, smaller, single‐center analysis of CMV R+ HT recipients from Australia, in which valganciclovir prophylaxis was associated with significantly reduced incidence of CMV infection (HR .07, .01–.72, p = .025) 18 . In our cohort, there was also a trend towards decreased 18‐month survival amongst PET treated patients which did not meet statistical significance.…”

Section: Discussionsupporting

confidence: 79%

“…These results build upon those of a recent, smaller, single-center analysis of CMV R+ HT recipients from Australia, in which valganciclovir prophylaxis was associated with significantly reduced incidence of CMV infection (HR .07, .01-.72, p = .025). 18 In our cohort, there was also a trend towards decreased 18-month survival amongst PET treated patients which did not meet statistical significance. Of further interest, pre-HT induction therapy with basiliximab was also associated with increased risk of CMV infection, and CMV-related hospitaliza- and possibly with cellular rejection.…”

Section: Discussioncontrasting

confidence: 54%

“…Evidence is limited to predominantly single-center retrospective studies, in many of which only one preventive strategy was applied uniformly to all R+ patients, preventing any analysis on the comparative efficacy of UP versus PET. 3,17,18 While randomized studies of PET versus UP in R+ renal transplant recipients have shown largely equivalent outcomes between the two strategies, the applicability of such data to the HT population is limited, given the increased levels of immunosuppression required in HT patients. 19,20 This evidence gap has contributed to the current consensus guidelines which do not provide a strong recommendation for use of either strategy over the other in CMV R+ HT patients.…”

Section: Discussionmentioning

confidence: 99%

“…To date, there have been no randomized trials to compare the relative efficacy of PET versus UP strategies in intermediate risk (CMV R+) HT recipients (whom comprise the majority of HT patients). Evidence is limited to predominantly single‐center retrospective studies, in many of which only one preventive strategy was applied uniformly to all R+ patients, preventing any analysis on the comparative efficacy of UP versus PET 3,17,18 . While randomized studies of PET versus UP in R+ renal transplant recipients have shown largely equivalent outcomes between the two strategies, the applicability of such data to the HT population is limited, given the increased levels of immunosuppression required in HT patients 19,20 .…”

Section: Discussionmentioning

confidence: 99%

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Multicenter study of universal prophylaxis versus pre‐emptive therapy for patients at intermediate risk (R+) for CMV following heart transplantation

Lerman

Green

Molina

et al. 2023

Clinical Transplantation

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IntroductionHeart transplant (HT) recipients with prior exposure to cytomegalovirus (CMV R+) are considered intermediate risk for CMV‐related complications. Consensus guidelines allow for either universal prophylaxis (UP) or preemptive therapy (PET) (serial CMV testing) approaches to CMV prevention in such patients. Whether an optimal approach to mitigate CMV related risks exists in this setting remains uncertain. We therefore assessed the utility of PET as compared to UP in CMV R+ HT recipients.MethodsRetrospective analysis of all CMV R+ HT recipients from 6 U.S. centers between 2010 and 2018 was performed. The primary outcome was the development of CMV DNAemia or end‐organ disease resulting in the initiation/escalation of anti‐CMV therapy. The secondary outcome was CMV‐related hospitalization. Additional outcomes included incidence of acute cellular rejection (ACR) ≥ grade 2R, death, cardiac allograft vasculopathy (CAV), and leukopenia.ResultsOf 563 CMV R+ HT recipients, 344 (61.1%) received UP. PET was associated with increased risk for the primary (adjusted HR 3.95, 95% CI: 2.65–5.88, p < .001) and secondary (adjusted HR 3.19, 95% CI: 1.47–6.94, p = .004) outcomes, and with increased ACR ≥ grade 2R (PET 59.4% vs. UP 34.4%, p < .001). Incidence of detectable CAV was similar at 1 year (PET 8.2% vs. UP 9.5%, p = .698). UP was associated with increased incidence of leukopenia within 6 months post‐HT (PET 34.7% vs. UP 43.6%, p = .036).ConclusionThe use of a PET CMV prophylaxis strategy in intermediate risk HT recipients associated with increased risk of CMV infection and CMV‐related hospitalization, and may associate with worse post‐HT graft outcomes.

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Section: Discussionsupporting

confidence: 79%

Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Multicenter study of universal prophylaxis versus pre‐emptive therapy for patients at intermediate risk (R+) for CMV following heart transplantation

Lerman

Green

Molina

et al. 2023

Clinical Transplantation

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“…Nevertheless, in contrast to this study, recurrences among positive QF‐CMV patients showed fast replication kinetics, with one patient experiencing severe colitis requiring ICU admission. Particularly in HTR and with ATG‐based induction, CMV infection has been associated with ICU admission in some reports 15 . The study by Chiereghin et al 11 .…”

Section: Discussionmentioning

confidence: 99%

Reliability of QuantiFERON®‐CMV in predicting CMV recurrence in heart transplant recipients: A single‐center retrospective study

Sermet,

Goeminne,

Hantz

et al. 2023

Clinical Transplantation

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BackgroundRecurrence after Cytomegalovirus (CMV) infection in heart transplant recipients is difficult to predict, in spite of its high incidence. Secondary prophylaxis could reduce this burden; however, its duration remains unestablished. We evaluated the QuantiFERON®‐CMV test to see if it could predict CMV recurrence and help optimize the duration of secondary prophylaxis.MethodsThis observational retrospective single center study included all heart transplant recipients who developed CMV infection between 2019 and 2021, with the CD8+ T‐cell‐mediated CMV immunity QuantiFERON®‐CMV test assessed at the time of (val)ganciclovir curative treatment completion. The main outcomes were CMV recurrence and duration of secondary prophylaxis. Secondary outcomes included immunosuppressive regimen, rejection, lymphocyte count, CMV viral load, infection type, and duration as possible confounding factors for recurrence.ResultsAmong the 15 patients included, five (33%) experienced recurrence, of whom three (60%) had a positive QuantiFERON®‐CMV test. The duration of secondary prophylaxis was similar regardless of QF‐CMV positivity. No confounding factor was significantly associated with CMV recurrence; however, it occurred in only 1/7 (14%) of the patients receiving an everolimus‐containing immunosuppressive regimen.ConclusionIn the population of heart transplant recipients, most of whom received ATG‐based induction, the QuantiFERON®‐CMV assay may not accurately predict CMV recurrence and would have not helped refining the duration of secondary prophylaxis in our patients. Other cell‐mediated immunity tests and strategies in this specific population, including everolimus‐containing regimens, may help predict and manage CMV recurrence.

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Incidence and Severity of Cytomegalovirus Infection in Seropositive Heart Transplant Recipients

Cited by 2 publications

References 0 publications

Multicenter study of universal prophylaxis versus pre‐emptive therapy for patients at intermediate risk (R+) for CMV following heart transplantation

Multicenter study of universal prophylaxis versus pre‐emptive therapy for patients at intermediate risk (R+) for CMV following heart transplantation

Reliability of QuantiFERON®‐CMV in predicting CMV recurrence in heart transplant recipients: A single‐center retrospective study

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