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

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

doi:10.1002/iid3.1075

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

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

Authors

Affiliations

¹ Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
² Department of Cardiac Surgery, Medical Faculty, RWTH Aachen University, Aachen, Germany.
³ Division of Cardiology, Pulmonology and Angiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.

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.

MeSH terms

Aged
Cytomegalovirus / genetics
Cytomegalovirus Infections* / epidemiology
Cytomegalovirus Infections* / etiology
Cytomegalovirus Infections* / prevention & control
Heart Transplantation* / adverse effects
Humans
Middle Aged
Retrospective Studies
Risk Factors