Impact of cytomegalovirus serologic status on heart transplantation

Alejandro Suarez-Pierre, Katherine Giuliano, Cecillia Lui, Daniel Almaguer, Eric Etchill, Chun W. Choi, Ahmet Kilic, Robert S. Higgins

Research output: Contribution to journalArticle

Abstract

Background: Cytomegalovirus (CMV) infection has been associated with increased risk of mortality, cardiac allograft vasculopathy, and de novo malignancy following heart transplantation in prior institutional reports. This study examines the impact of the recipient and donor CMV status on heart recipients in the United States. Methods: Adult heart transplant recipients were identified in the OPTN registry between 2005-2016. Recipients were stratified based on the recipient (R) and donor (D) CMV serologic status (+/−). The primary endpoint was survival 5-years after transplantation. The secondary endpoint was cardiac allograft vasculopathy 5-years after transplantation. Separate Cox proportional hazards regression models were developed to evaluate independent associations between CMV status and each of the study endpoints. Results: A total of 21 878 recipients met the inclusion criteria. The breakdown of study arms by CMV serologic status was R−/D− = 3412, R+/D− = 4939; R−/D+ = 5230, and R+/D+ = 8,297. Five-year survival estimates were similar across groups (77-79%). CMV status was associated with increased mortality at 5-years (23%-41% increased risk) which was most evident in the first 3 months. The use of valganciclovir was associated with decreased risk of mortality (HR 0.56; 95% CI, 0.52-0.60). The cumulative incidence of cardiac allograft vasculopathy (R−/D− = 31%, R+/D− = 30%, R−/D+ = 31%, and R+/D+ = 30%) was similar across groups. CONCLUSIONS: CMV seropositivity at the time of transplantation is associated with increased long-term risk of mortality. Chemoprophylaxis with antivirals seems to mitigate this risk. There was no association with an increased risk of allograft vasculopathy.

Original languageEnglish (US)
JournalJournal of Cardiac Surgery
DOIs
StateAccepted/In press - Jan 1 2020

Keywords

  • cardiac allograft vasculopathy
  • cytomegalovirus
  • heart transplantation
  • survival

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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