Breakthrough Cytomegalovirus DNAemia in High vs Intermediate Risk Heart Transplant Recipients

G. Huang¹, O. E. Beaird¹, M. Davis², M. Carlson¹, S. Chang¹, P. Gaynor¹, A. Fan², M. Deng³, A. Multani¹, A. Nsair³, J. Schaenman¹

¹Infectious Diseases, UCLA, Los Angeles, CA, ²Pharmacy, UCLA, Los Angeles, CA, ³Cardiology, UCLA, Los Angeles, CA

Meeting: 2021 American Transplant Congress

Abstract number: 740

Keywords: Cytomeglovirus, Heart, Prophylaxis

Topic: Clinical Science » Infectious Disease » All Infections (Excluding Kidney & Viral Hepatitis)

Session Information

Session Name: All Infections (Excluding Kidney & Viral Hepatitis)

Session Type: Poster Abstract

Session Date & Time: None. Available on demand.

Location: Virtual

*Purpose: Cytomegalovirus (CMV) is one of the most common infections after transplantation and continues to cause significant morbidity and mortality despite prophylaxis and screening strategies. Guidelines recommend 3-6 months of post-transplant prophylaxis with 900mg daily of valganciclovir (VGC) in intermediate (R+) and high risk (D+/R-) heart transplant recipients. At our institution, R+ patients receive 450mg daily of VGC for 6 months and for high risk (D+/R-) patients 900 mg daily for 12 months. In this study we aim to determine rates of CMV DNAemia among these 2 groups and to examine if the 450 mg dose is effective at preventing CMV DNAemia.

*Methods: Retrospective chart review of adult patients (>= 18 yo) undergoing heart transplantation at a single center from January 2017-December 2019.

*Results: One-hundred and thirty-nine patients received a heart transplant between January 2017 and December 2019. Of those, 16 were identified as “low risk” (CMV D-/R-) and excluded. Of the 123 remaining patients, 83 were male and the median age at time of transplantation was 56. Thirty-six patients (29.3%) of patients experienced CMV DNAemia within 1 year of transplantation and 17 (13.8%) had a CMV DNA above the detectable threshold. Age, induction with anti-thymocyte globulin, rejection at 1 year, and mortality at 1 year did not differ between the groups. CMV DNAemia above the quantifiable threshold along with discharge on the equivalent of 900mg daily of VGC was significantly higher in the high-risk group (Table). In the high-risk group, 6 (21.4%) were discharged on lower doses of VGC due to renal dysfunction. Of the patients with breakthrough CMV DNAemia, 4 of 9 patients were on prophylaxis at the time in the high-risk group (44.4%) and 2 of 8 patients in the intermediate group (25%).

*Conclusions: Despite having a larger proportion of patients on 900mg daily of valganciclovir, the high-risk patients developed a higher incidence of CMV DNAemia at 1 year compared to the intermediate risk population. The rate of CMV DNAemia in the intermediate risk group was low. Whether adherence to the 900 mg daily dose can decrease rates of DNAemia is currently under investigation in a larger patient cohort.

To cite this abstract in AMA style:

Huang G, Beaird OE, Davis M, Carlson M, Chang S, Gaynor P, Fan A, Deng M, Multani A, Nsair A, Schaenman J. Breakthrough Cytomegalovirus DNAemia in High vs Intermediate Risk Heart Transplant Recipients [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/breakthrough-cytomegalovirus-dnaemia-in-high-vs-intermediate-risk-heart-transplant-recipients/. Accessed November 21, 2024.

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