Does cytomegalovirus status influence acute and chronic rejection in heart transplantation during the ganciclovir prophylaxis era?

Abstract

Background: The effect of cytomegalovirus (CMV) status on acute rejection in heart transplantation is not well understood. Furthermore, there is some evidence to suggest that CMV antibody positivity is associated with cardiac allograft vasculopathy (CAV). Methods: This study compared the effect of CMV antibody status in heart transplant donors (D) and recipients (R) on acute and chronic rejection episodes during the ganciclovir prophylaxis era. Results: All heart transplant recipients at Papworth Hospital during the ganciclovir prophylaxis era were included ( n = 374). They were grouped according to recipients and their respective donor CMV serology: R −/D − ( n = 82); R +/D − ( n = 114); R −/D + ( n = 73); and R +/D + ( n = 105). Ganciclovir prophylaxis was administered to the R −/D + group. The mean (SD) recipient and donor ages were 46 (11), 51 (9), 47 (11) and 52 (8) years ( p < 0.001), and 32 (11), 33 (14), 36 (12) and 38 (14) years ( p = 0.01), respectively, for the CMV groups. The mean number of acute rejection episodes (as confirmed by cardiac biopsy) per 100 patient-days was 0.13 (0.36), 0.11 (0.34), 0.12 (0.34) and 0.12 (0.34), respectively ( p > 0.05) There was no statistical difference in the development of CAV as assessed by angiography ( p = 0.92). At 2 years, the “freedom from CAV” rates were 96%, 97%, 97% and 98%, respectively. The 5-year post-operative survival rates were 83%, 79%, 67% and 73% ( p = 0.08 overall). Conclusions: CMV status of heart transplant recipients and their respective donors does not influence acute or chronic rejection in terms of cardiac allograft vasculopathy.