Cytomegalovirus Infection among Pediatric Heart Transplant Recipients in the Current Era of Valganciclovir Prophylaxis: Impact on Post-Transplant Outcomes

Abstract

Purpose To study the relation between the presence and absence of asymptomatic CMV infection in the first year after heart transplant (HT) and subsequent rejection, cardiac allograft vasculopathy (CAV) and graft loss in the era of valganciclovir prophylactic treatment . Methods Retrospective study of 97 pediatric HT recipients between 2010 and 2016, pre- and post-HT variables were extracted from electronic medical records . Asymptomatic CMV infection was defined as quantifiable CMV PCR value of >1000 copies/ml and/or positive anti-CMV antibody by immunofluorescence (IFA) in myocardial samples during first year of HT. Results Total 42 pediatric HT recipients (43%) received valganciclovir prophylaxis. Overall, 34% (33/97) of patients developed asymptomatic CMV infection within one year following transplant. Valganciclovir prophylaxis decreased the number of CMV-PCR positive infections (p myocardium (p= 0.001) (Figure-2). Individuals with CMV infection were at increased rate of allograft rejections after one year compared to those with no CMV infection (p = 0.009). However, incidence of CAV and graft loss after first year of HT with or without CMV infection was not significant (log-rank p = 0.233 and p = 0.4, respectively). Conclusion Our study supports the emerging evidence that valganciclovir prophylaxis prevent CMV infection in pediatric HT recipients and may be helpful in reducing long-term complications such as CAV and graft loss.