Cytomegalovirus Infections are Frequent after Heart Transplantation but Do Not Increase the Risk of Biopsy-Proven Allograft Rejection in the Modern Era

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Our aim was to analyze the clinical impact of CMV infections on the risk of allograft rejection. We conducted a single-center retrospective study including patients transplanted between January 2012 and December 2016 who had at least one endomyocardial biopsy (EMB) during follow-up. Patients at high risk of CMV infections (D+/R-) received valganciclovir prophylaxis for 3 months, those at intermediate risk (R +) were treated according to a preemptive strategy (viral replication threshold: 10,000 IU / mL). Protocol monitoring included 13 B.M. per patient in the first year. Allograft rejection was defined as ≥ 1R1B acute cellular rejection or ≥ pAMR1 antibody-mediated rejection according to international guidelines. The impact of CMV infection, defined as a viral replication ≥ 10,000 IU / mL, on the risk of allograft rejection was analyzed using a mixed effects logistic regression. 399 patients met the inclusion criteria, including 60 patients D+/ R-, 256 R+ and 72 D+/R. All patients received an induction therapy and a triple basal immunosuppression. We observed a dynamic risk of infection during the first year according to the baseline CMV serology (Figure 1A). CMV infections were diagnosed in more than half of the patients (Figure 1B). 140 patients (35%) had at least one episode of biopsy-proven rejection. In univariable analyses, CMV infections were not associated with an increased risk of rejection in month following infection (0R=1.03, 95%CI=0.6-1.7, p=0.91). After adjustment for the presence of DSA, the number of HLA AB-DR-DQ mismatches, recipient age and time post-transplant, CMV infections were not associated with the risk of rejection in month following infection (OR=0.9, 95%CI=0.5-1.5, p=0.61). Different timing post-infection have been evaluated but were not associated with rejection. CMV infections were common after heart transplantation but were not associated with the risk of allograft rejection.