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. 2023 Nov;11(11):e1075.
doi: 10.1002/iid3.1075.

Evaluation of risk factors for cytomegalovirus DNAemia after end of regular prophylaxis after heart transplantation

Moritz Benjamin Immohr  1   2 , Daniel Oehler  3 , Freya Sophie Jenkins  1 , Nikolas Kalampokas  1 , Vincent Hendrik Hettlich  1 , Dennis Sigetti  1 , Fabian Voß  3 , Hannan Dalyanoglu  1 , Hug Aubin  1 , Payam Akhyari  1   2 , Artur Lichtenberg  1 , Udo Boeken  1
Affiliations

Evaluation of risk factors for cytomegalovirus DNAemia after end of regular prophylaxis after heart transplantation

Moritz Benjamin Immohr et al. Immun Inflamm Dis. 2023 Nov.

Abstract

Background: Cytomegalovirus (CMV) infections after heart transplantation (HTx) can cause cardiac allograft vasculopathy. Consequently, monitoring and prophylaxis for cytomegalovirus deoxyribonucleic acid (CMV-DNAemia) within the first weeks after HTx is recommended.

Methods: All patients who underwent HTx between September 2010 and 2021 surviving the first 90 days (n = 196) were retrospectively reviewed. The patients were divided on the prevalence of CMV-DNAemia during the first postoperative year after the end of the prophylaxis. A total of n = 35 (20.1%) developed CMV-DNAemia (CMV group) and were compared to patients without CMV-DNAemia (controls, n = 139). The remaining patients (n = 22) were excluded due to incomplete data.

Results: Positive donors and negative recipients (D+/R-) and negative donors and positive recipients (D-/R+) serology was significantly increased and D-/R- decreased in the CMV group (p < .01). Furthermore, the mean age was 57.7 ± 8.7 years but only 53.6 ± 10.0 years for controls (p = .03). Additionally, the intensive care unit (p = .02) and total hospital stay (p = .03) after HTx were approximately 50% longer. Interestingly, the incidence of CMV-DNAemia during prophylaxis was only numerically increased in the CMV group (5.7%, respectively, 0.7%, p = .10), the same effect was also observed for postoperative infections. Multivariate analyses confirmed that D+/R- and D-/R+ CMV immunoglobulin G match were independent risk factors for postprophylaxis CMV-DNAemia.

Conclusion: Our data should raise awareness of CMV-DNAemia after the termination of regular prophylaxis, as this affects one in five HTx patients. Especially old recipients as well as D+/R- and D-/R+ serology share an elevated risk of late CMV-DNAemia. For these patients, prolongation, or repetition of CMV prophylaxis, including antiviral drugs and CMV immunoglobulins, may be considered.

Keywords: cardiac allograft vasculopathy; cytomegalovirus; heart transplantation; prophylaxis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Schematic illustration of the study protocol. CMV, cytomegalovirus; CMV‐DNAemia, CMV deoxyribonucleic acid; CMV IVIG, intravenous CMV immunoglobulins.
See this image and copyright information in PMC

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