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

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.