Is Donor/Recipient Cytomegalovirus Mismatch Truly Associated with Increased Risk for Cardiac Allograft Vasculopathy in the Current Era?

Abstract

<h3>Purpose</h3> Cytomegalovirus (CMV) infections have been associated with the subsequent development of cardiac allograft vasculopathy (CAV) after heart transplantation (HTx). This is most prominent with patients receiving a donor with positive CMV serology when the patient is CMV serology negative. This mismatched patient cohort was subsequently reviewed for the development of CMV serology positivity, CMV syndrome, and CMV disease (specific organ involvement). <h3>Methods</h3> Between 2010 and 2016, we assessed 138 HTx patients who had CMV mismatch (donor positive/recipient negative). Patients were treated with CMV prophylaxis with Valcyte for 1 year. CMV patients were then divided (data at 1-year) into those that developed serology positive CMV on IgG, CMV syndrome (who presented with fever, chills, and sweats), CMV disease (organ specific disease, such as retinitis, peritonitis, gastroenteritis). All groups were then assessed for 5-year survival and the development of CAV by angiography. <h3>Results</h3> In CMV mismatched patients, there was no significant difference in 5-year survival or freedom from angiographic CAV in those patients with clinical CMV (asymptomatic IgG positive, CMV syndrome, CMV disease groups) compared to the asymptomatic IgG negative group. <h3>Conclusion</h3> In the current era, CMV mismatch patients (donor positive/recipient negative CMV serology) do not appear to be at increased risk for poor outcome. Valcyte prophylaxis for 1 year may be beneficial.