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Postlung transplant survival is equivalent regardless of cytomegalovirus match status
Mark J Russo1, David I Sternberg, Kimberly N Hong
1Lung Transplant Program and International Center for Health Outcomes and Innovation Research, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
Insights
Cytomegalovirus (CMV) matching status no longer impacts lung transplant survival in the current era. Aggressive CMV prophylaxis means CMV mismatch should not prevent lung allograft offers.
Area of Science:
- Transplantation Medicine
- Infectious Diseases
- Immunology
Background:
- Cytomegalovirus (CMV) serologic status in organ donors and recipients can influence post-transplant outcomes.
- Understanding the impact of CMV matching on lung transplant survival is crucial for optimizing patient management.
Purpose of the Study:
- To evaluate the relationship between donor-recipient CMV serologic status and lung transplant survival in the current era.
- To analyze temporal trends in post-transplant survival based on CMV matching status over time.
Main Methods:
- Utilized de-identified data from the United Network for Organ Sharing for lung transplants.
- Compared post-transplant survival among CMV serologic groups (D+/R-, D+/-/R+, D-/R-) from 2000-2004.
- Analyzed temporal survival trends from 1990-2004 using Kaplan-Meier analysis.
Main Results:
- In the 2000-2004 era, no significant differences in survival were observed across CMV matching groups.
- Earlier eras (1990-1999) showed significant survival differences based on CMV status.
- Survival improved over time for D+/R- and D+/-/R+ groups, but not for D-/R-.
Conclusions:
- Current lung transplant survival is statistically equivalent regardless of CMV match status.
- CMV mismatch should not be a reason to refuse a lung allograft offer due to effective CMV prophylaxis.
- These findings support broader acceptance criteria for lung allografts.
Background:
The purpose of this study was to assess (1) the relationship between donor-recipient cytomegalovirus (CMV) serologic status and posttransplant survival in the current era and (2) temporal changes in posttransplant survival by CMV matching status.
Methods:
De-identified data were obtained from the United Network for Organ Sharing. Based on pretransplant CMV serologic status (+ or -) of recipients (R) and donors (D), posttransplant survival was compared among three groups: D+ /R-, D+/- /R+, and D- /R-. Primary analysis focused on transplants performed January 1, 2000 to December 31, 2004, in recipients 18 years of age or older. To assess temporal trends in survival among groups, all lung transplants occurring between January 1, 1990, and December 31, 2004, were considered and divided into three periods based on transplant year: 1990 through 1994, 1995 through 1999, and 2000 through 2004. The primary outcome measure was survival, reported as rate of death per 100 patient-years. Kaplan-Meier analysis with log-rank test was used for time-to-event analysis.
Results:
During the current era (2000 through 2004), D+ /R- (n = 951), D+/- /R+ (n = 2,676), and D- /R- (n = 772) exhibited no differences in survival (p = 0.561), with rates of death per 100 patient-years of 16.6 (95% confidence interval, 14.9 to 18.5), 15.0 (95% confidence interval, 14.0 to 16.0), and 14.7 (95% confidence interval, 13.0 to 16.6), respectively. However, survival was significantly different for groups in the earlier eras of 1990 through 1994 (p < 0.001) and 1995 through 1999 (p < 0.001). During the three periods, survival improved significantly in D+ /R- (p < 0.001) and D+/- /R+ (p < 0.001), but survival in D- /R- (p = 0.351) did not change significantly with time.
Conclusions:
In the current era, survival after lung transplantation is statistically equivalent regardless of CMV match status. Although in previous eras survival was worse among the D+/- /R+ and D+ /R- groups, in this era of aggressive CMV prophylaxis, CMV mismatch should not be sufficient grounds to decline a lung allograft offer.
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