Abstract
Purpose Thymoglobulin (ATG) is commonly used as induction therapy immediately after heart transplantation (HTx). ATG has been associated with an increase in CMV infection when used with maintenance cyclosporine. In the current era, tacrolimus has replaced cyclosporine as the main maintenance immunosuppressive agent. It is not clear whether ATG induction does indeed lead to more CMV infection in the tacrolimus era. Methods Between 2010 and 2016, we assessed 342 patients who received ATG induction therapy and compared them with HTx patients who did not receive ATG (n=312). ATG is routinely administered to patients with renal insufficiency to delay tacrolimus initiation and to sensitized patients (PRA ≥ 10%). Patients treated with ATG were then divided into their donor/recipient CMV serology matching (D+R-, D+R+, D-R+ and D-R-) and analyzed for the development of CMV infection defined as patients presenting with clinical symptoms and detected CMV virus via PCR. Incidence of rejection was also evaluated. Valcyte is routinely administered for CMV prophylaxis. Results There was a trend towards an increase in CMV infection in patients who received ATG induction therapy after HTx (see table). When the ATG population was analyzed by CMV serology, CMV mismatch (D+R-) had a numerical increase in CMV infection but this result was not statistically significant. When compared to the D-R- group on pairwise analysis, there was a trend towards increase in CMV infection and any-treated rejection in the CMV mismatch group (D+R-). (see table). Of note, valcyte induction was similar between groups per the transplant protocol. Conclusion ATG therapy trends towards increased CMV infection post-transplant in the tacrolimus era. Patients who have been treated with ATG and have CMV mismatch (D+R-) may have increased CMV infection risk as well as rejection risk by 2-years after HTx. Larger numbers are needed to confirm these findings.
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