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Impact of donor and recipient cytomegalovirus serology on long‐term survival of heart transplant recipients
Author(s) -
Mabilangan Curtis,
Preiksaitis Jutta K.,
Cervera Carlos
Publication year - 2019
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.13015
Subject(s) - serostatus , medicine , valganciclovir , ganciclovir , cytomegalovirus , transplantation , serology , proportional hazards model , heart transplantation , retrospective cohort study , cohort , human cytomegalovirus , immunology , viral load , herpesviridae , viral disease , virus , antibody
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 1 (Pre‐ganciclovir, July 1985‐April 1998), Era 2 (Oral ganciclovir, May 1998‐December 2004), Era 3 (Valganciclovir, January 2005‐December 2015). 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.