Abstract
Cytomegalovirus (CMV) infection following heart transplant is associated with increased morbidity and mortality. We evaluated the impact of CMV status on long term survival at all UK centres, employing different approaches to managing CMV. Adult patients undergoing heart transplantation and surviving >30 days between March 1987 and August 2018 included. Data obtained from NHS Blood and Transplant included CMV donor (D) and recipient (R) status, age, sex, centre, treated rejection episodes and survival. Patients grouped by CMV status: D-ve R-ve (DN), D+ve R-ve (PM), D+ve R+ve (DP), D-ve R+ve (RM). 5 year survival, adjusted for age, sex and centre, was compared between all CMV groups, with individual comparisons between DN patients and other statuses. Survival between centres, adjusted for age and sex also compared. Survival data compared using Cox-proportional hazards. Rates of treated rejection between CMV groups compared using Chi2 test. 2675 patients included from 6 UK transplant centres; 2 use a pre-emptive strategy, 4 use valganciclovir in PM patients and high risk R+ve patients for 3-6 months. Five year survival per group CMV DN 629/750 (83.9%), PM 440/563 (78.1%) RM 655/773 (84.7%) DP 467/592 (78.8%). Compared to DN, both PM (HR 1.43 p=0.005) and DP (HR 1.34 p=0.025) were associated with significantly higher mortality. There was no survival difference between centres, p= 0.127, and no difference between centres for PM (p=0.69) or DP (0.23) groups. Rates of treated rejection at 12 months were higher in PM and DP patients, difference between groups p=0.0033. To our knowledge, this is the first multicentre evaluation of the impact of CMV status on longer term survival following heart transplant. CMV mismatch and double positive statuses were associated with higher rates of rejection and reduced survival, irrespective of the CMV prevention strategy used. This should be considered when counselling patients, and in adjusted survival analyses.
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