Long-Term Outcomes Among Lung Transplant Recipients With High-Risk Cytomegalovirus Mismatch Managed With a...

Lung transplant (LT) recipients with high-risk cytomegalovirus (CMV) mismatch donors (donor seropositive, recipient seronegative) have worse early and late outcomes. We sought to describe the outcomes among high-risk mismatch patients managed using proactive monitoring and multimodality prophylaxis and management protocol.

We included patients with single or bilateral lung transplants between January 2012 and December 2016 (n = 324). The patients were classified into two groups: high-risk CMV mismatch (R-/D+): n = 83 (25.6%) and non-high-risk CMV mismatch (n = 241). Post-LT follow-up period ranged from 8 to 12 years. Post-transplant survival was analyzed as the primary outcome variable.

There was no difference in LT recipients' baseline and post-transplant characteristics with and without CMV-mismatch donors. The mismatch group experienced a significantly higher frequency and burden of CMV viremia (p < 0.001) and resistant viremia (p < 0.001). Regardless, the two groups had similar long-term outcomes with no statistically significant difference in CLAD-free survival at 3 years or overall post-transplant survival. On Cox proportional hazard analysis, transplant indication was the only independent predictor of post-transplant survival (p = 0.004).

A proactive multimodality CMV management protocol consisting of antiviral agents (ganciclovir/valganciclovir) and immune augmentation with CMV immune globulin may improve outcomes among high-risk CMV mismatch LT recipients.