Background

Orthotopic heart transplantation (OHT) continues to be the gold standard for the management of patients with end-stage heart failure. However, complications following OHT may result in significant morbidity and mortality. In this study, we describe our experience with cytomegalovirus (CMV) infection following OHT.

Methods

This is a retrospective cohort analysis of all patients who underwent OHT between December 1, 1988 and October 21, 2014 through the BC Heart Transplant Program. Patients who received multiple induction agents/transplants or had missing data were excluded. Freedom from CMV infection at 10-years was compared by donor (D)/recipient (R) CMV status at a time of OHT. A Cox regression analysis of survival and freedom from CMV infection was performed controlling for age, sex, CMV prophylaxis, D/R CMV status, and induction agent.

Results

Over the study period, a total of 406 patients were transplanted, 32 of whom were excluded. Of the remaining 374 patients, the median age was 54.5 (IQR 46.9 – 60.8) years and 288 (77.0%) were male. At 10-years, the overall rate of freedom from CMV infection was 73.4%. There was a significant difference in freedom from CMV infection at 10-years between the patients in the following D/R CMV status groups: D-R- (95.0%, n=73), D-R+ (73.7%, n=104), D+R- (56.2%, n=71), and D+R+ (71.8%, n=126) (Figure 1). After multivariable analysis, there was a significantly higher hazard ratio for CMV infection at 10-years associated with D-R+ (5.36, 95% CI [1.61, 17.85], p=0.006), D+R+ (6.64, 95% CI [2.03, 21.77], p=0.002), and D+R- (9.27, 95% CI [2.63, 32.70], p=0.001) status when compared with D-R- status. Induction agents were not associated with a difference in freedom from CMV infection. There was no association with CMV infection and mortality at 10-years.

Conclusion

In this study, there was a significant difference in freedom from CMV infection between patients stratified by D/R CMV status, irrespective of age, sex, induction agent, and CMV prophylaxis. Patients with D+R- CMV status had the lowest rate of freedom from CMV infection at 10-years.

CITATION INFORMATION: Kiamanesh O, Khosla A, Imai C, Johansson E, Virani S, Davis M, Cheung A, Bashir J, Munt B, Ignaszewski A, Kaan A, Toma M. Cytomegalovirus Infection After Cardiac Transplantation. Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress