Abstract
Purpose Cytomegalovirus (CMV) is correlated with a number of complications following heart transplantation (HTx). The impact of a serologic mismatch between donor and recipient is still controversially discussed. Especially the necessity of prophylactic virostatic medication is a matter of concern. Therefore, we aimed to analyse the impact of preoperative CMV matching on perioperative morbidity and mortality after HTx. Methods We retrospectively reviewed all 178 patients, which underwent HTx between 2010 and 2020 in our department. Patients were divided with regard to their pretransplant CMV matching. The recipients could be categorized into 4 groups depending on their serologic CMV matching (Group 1: donor and recipient CMV-IgG positive (=D+/R+), n=52; Group 2: (D+/R-), n=31; Group 3: (D-/R+), n=49; Group 4: (D-/R-), n=34). The remaining patients were excluded due to missing information about the donors CMV status. Patients and donors were comparable concerning co-morbidities and risk factors for impaired posttransplant outcome. Results Incidence of primary graft dysfunction (PGD), perioperative neurological events, bleeding complications, severe infections and early graft rejection (>1R) were comparable between all groups (p>0.05). In contrast, the incidence of postoperative acute kidney injury with need for hemodialysis was significantly increased in Group 3 (73.9%) compared to the other groups (57.7% in Group 1, 40.0% in Group 2 and 52.9% in Group 4, p=0.03). Posttransplant CMV viremia was observed in serologic positive recipients only (Group 1: 13.3%, Group 2: 0.0%, Group 3: 25.0%, Group 4: 0.0%, p Conclusion Except for kidney function, we did not observe any differences in perioperative morbidity and mortality regarding CMV matching in our cohort. Seropositive recipients carry the most important risk factor of posttransplant CMV viremia. In contrast, the so-called “high-risk” CMV configuration (D+/R-) showed no impairments of postoperative outcome compared to “low-risk” (D-/R-), which may be related to positive effects of regularly administered prophylactic virostatic medication in the “high-risk” cohort.
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