High-risk Cytomegalovirus in Heart Transplant: How Can We Improve?

Area of Science:

• Transplantation Immunology
• Infectious Diseases
• Cardiology

Background:

• Cytomegalovirus (CMV) infection is linked to poorer outcomes in heart transplant (HT) recipients.
• CMV serological mismatch (donor positive, recipient negative - D+/R-) significantly elevates infection risk.
• Current guidelines recommend 3-6 months of antiviral prophylaxis for D+/R- HT patients.

Purpose of the Study:

• To analyze the incidence and patterns of CMV infection in D+/R- heart transplant recipients.
• To identify potential areas for improvement in managing CMV in this high-risk population.
• To evaluate the effectiveness of current prophylactic strategies.

Main Methods:

• Retrospective analysis of 35 adult HT recipients with CMV D+/R- mismatch over 10 years.
• Patients were followed until October 2023.
• Evaluation of CMV transmission patterns and infection rates in relation to prophylaxis duration.

Main Results:

• CMV infection occurred in 74% of patients, primarily within 6 months after prophylaxis cessation.
• CMV disease developed in 26% of patients, with half requiring hospitalization.
• Survival at follow-up was 77%, with two deaths attributed to CMV infection-related complications.

Conclusions:

• The high rate of CMV infection in D+/R- HT recipients persists despite guideline-recommended prophylaxis.
• Understanding CMV transmission dynamics is crucial for optimizing prevention and rejection management.
• Tailored protocols are essential to improve outcomes for this high-risk HT population.