Predictors of Cytomegalovirus Recurrence Following Cessation of Posttransplant Prophylaxis

Area of Science:

• Transplantation immunology
• Infectious diseases
• Post-transplant complications

Background:

• Cytomegalovirus (CMV) infection poses a significant risk for poor outcomes in lung transplant recipients.
• Donor and recipient CMV serostatus is a known risk factor for CMV reactivation post-transplant.
• While CMV prophylaxis is standard for the first year, long-term reactivation risks require further investigation.

Purpose of the Study:

• To investigate the timing and risk factors associated with Cytomegalovirus (CMV) infection following lung transplantation.
• To evaluate the impact of CMV mismatch on long-term CMV infection after standard prophylaxis.

Main Methods:

• Retrospective review of a lung transplantation database (June 2014 - June 2022).
• Data collected included patient characteristics, pre-transplant lab values, and post-operative outcomes.
• CMV mismatch was defined as donor CMV-IgG-positive and recipient CMV-IgG-negative status.

Main Results:

• Out of 257 lung transplant recipients receiving up to 1-year valganciclovir prophylaxis, 69 (26.8%) developed CMV infection.
• CMV infection occurred in 53.7% of the CMV mismatch group versus 19.7% in the non-CMV mismatch group (P < 0.001).
• Independent predictors for CMV infection included CMV mismatch (OR=15.7), donor age (OR=1.05), and preoperative albumin level (OR=0.39).

Conclusions:

• CMV mismatch is a significant risk factor for CMV infection after lung transplantation, even after prophylaxis.
• Low preoperative albumin levels and increased donor age are also independent predictors of CMV infection.
• Understanding these risk factors can help refine long-term management strategies for lung transplant recipients.