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Impact of cytomegalovirus serologic status on heart transplantation
Author(s) -
SuarezPierre Alejandro,
Giuliano Katherine,
Lui Cecillia,
Almaguer Daniel,
Etchill Eric,
Choi Chun W,
Kilic Ahmet,
Higgins Robert S
Publication year - 2020
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.14588
Subject(s) - medicine , valganciclovir , transplantation , serology , heart transplantation , proportional hazards model , cytomegalovirus , chemoprophylaxis , clinical endpoint , malignancy , immunosuppression , incidence (geometry) , cumulative incidence , immunology , human cytomegalovirus , cytomegalovirus infection , viral disease , clinical trial , antibody , herpesviridae , virus , physics , optics
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.