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Impact of late‐onset cytomegalovirus infection in the development of cardiac allograft vasculopathy in heart transplant recipients
Author(s) -
Ponz de Antonio Inés,
Rodríguez Chaverri Adriana,
García Reyne Ana,
Carrasco Antón Nerea,
Lora Pablos David,
López Medrano Francisco,
Dios Santiago,
Jurado Alfonso,
Folgueira María D.,
GarcíaCosio Carmena María D.,
Arribas Ynsaurriaga Fernando,
Aguado José M.,
Lumbreras Carlos,
Delgado Jiménez Juan F.
Publication year - 2021
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.13479
Subject(s) - medicine , cytomegalovirus , heart transplantation , epidemiology , cytomegalovirus infection , retrospective cohort study , human cytomegalovirus , betaherpesvirinae , transplantation , young adult , multivariate analysis , gastroenterology , immunology , herpesviridae , viral disease , virus
Background The impact of late‐onset cytomegalovirus (CMV) infection (LOCI) on cardiac allograft vasculopathy (CAV) has yet to be established. Methods A retrospective study was performed for patients who had undergone heart transplantation (HT) between January 1995 and October 2017 to analyze epidemiology of LOCI (any positive level of CMV pp65 antigenemia or DNAemia after 100 days, without previous CMV replication) and its association with CAV. Our main hypothesis was that LOCI causes less direct and indirect effects compared to early onset infection (EOCI). Results Late‐onset cytomegalovirus infection developed in 57 of 410 patients (13.9%) in a median time of 4.7 months post‐transplant. CAV at 10 years was diagnosed in 31.6% of patients with LOCI, 34.6% with EOCI, and in 19.3% of CMV‐uninfected patients. In the multivariate analysis, EOCI was an independent variable for developing CAV (HR 1.8, 95% CI 1.13‐2.82, P = .01). Patients with LOCI showed a trend toward a higher risk of CAV, but the difference was not statistically significant (HR 1.7, 95% CI 0.95‐3.08, P = .07). In the complementary log‐log model, LOCI and EOCI had a similar CAV‐free survival, and a higher probability of developing CAV than CMV‐uninfected patients ( P = .02). Conclusions Cytomegalovirus infection after HT may result in the same long‐term events regardless of its onset, with a higher risk of developing CAV at 10 years than patients without CMV.