Impact of cytomegalovirus serologic status on heart transplantation

Area of Science:

• Cardiology
• Infectious Diseases
• Transplantation Immunology

Background:

• Cytomegalovirus (CMV) infection is a known risk factor for adverse outcomes post-heart transplant.
• Prior studies suggest CMV increases mortality, cardiac allograft vasculopathy, and malignancy risk.
• This study investigates the impact of recipient and donor CMV status on U.S. heart transplant recipients.

Purpose of the Study:

• To determine the association between cytomegalovirus (CMV) serologic status and long-term outcomes in adult heart transplant recipients.
• To evaluate the impact of CMV status on 5-year survival and cardiac allograft vasculopathy.
• To assess the effect of antiviral chemoprophylaxis on mortality risk in CMV-positive heart transplant recipients.

Main Methods:

• Analysis of adult heart transplant recipients from the OPTN registry (2005-2016).
• Stratification of recipients based on donor and recipient cytomegalovirus (CMV) serologic status.
• Cox proportional hazards regression models to assess associations between CMV status and 5-year survival and cardiac allograft vasculopathy.

Main Results:

• Five-year survival rates were similar across all cytomegalovirus (CMV) serologic groups (77-79%).
• CMV seropositivity was associated with a 23%-41% increased risk of mortality, particularly within the first 3 months post-transplant.
• Valganciclovir use significantly decreased mortality risk (HR 0.56; 95% CI, 0.52-0.60).
• Cardiac allograft vasculopathy incidence was similar across all CMV status groups (30-31%).

Conclusions:

• CMV seropositivity at heart transplantation is linked to an elevated long-term mortality risk.
• Antiviral chemoprophylaxis appears effective in mitigating the increased mortality risk associated with CMV.
• No significant association was found between CMV status and an increased risk of cardiac allograft vasculopathy.