Date: Sunday, May 3, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Purpose: CMV is a significant complication in heart transplant recipients (HTR). Little evidence exists to guide prophylaxis in moderate risk (R+) patients.
Methods: An IRB-approved review of all moderate risk (recipient IgG+) HTR transplanted from 10/2011-8/2013 was conducted at a single center; pertinent data was collected for the first post-transplant year. CMV reactivation (CMV-R) was defined as a treated viremia (>200 copies/mL) or tissue-invasive disease (pathologically proven). All R+ recipients who received thymoglobulin induction (used to delay initiation of tacrolimus) received 3 months of valganciclovir followed by 3 months of valacyclovir (THYMO/VGCV); R+ HTR receiving steroid-only induction received 6 months of valacyclovir (STER/VAC).
Results: 51 R+ HTR were included. The 1-year CMV-R rate was 23.5% (12/51); all CMV-R was treated viremia. Demographics and donor status did not affect reactivation; immunosuppression was similar at time of prophylaxis stop (Table 1). Incidence of CMV-R in R+ HTR receiving THYMO/VGCV was significantly lower than R+ HTR receiving STER/VAC (12.1% vs 44.4%, p=0.009). Time to CMV-R was also longer in THYMO/VGCV (p<0.001). Rejection following CMV-R was higher in STER/VAC. Viral load was similar between groups, and readmission was required in 25% of cases (Table 2).
|Overall Cohort (N=51)||CMV Reactivation (N=12)||No CMV Reactivation (N=39)||p|
|Age, mean (range)||56.3 (28-70)||57.9 (39-70)||55.8 (28-70)||0.6|
|Male Gender, n (%)||35 (68.6)||7 (58.3)||28 (71.8)||0.38|
|Caucasian race, n (%)||34 (66.6)||9 (75)||25 (64.1)||0.48|
|Donor status CMV +||30 (58.8)||7 (58.3)||23 (59)||0.91|
|Mean MMF dose at ppx d/c, mg||1465||1091||1594||0.067|
|Mean tacrolimus level at ppx d/c, ng/mL||11.4||9.18||12.1||0.038|
|Median time from transplant to treated rejection, days||43.5||45||40||0.12|
|CMV reactivation, n (%)||4/33 (12.1)||8/18 (44.4)||0.009|
|Mean thymoglobulin dose, mg/kg||2.69||0||<0.001|
|Time to CMV reactivation, days||197||48||<0.001|
|Rejection prior to CMV, n (%)||1/4 (25)||3/8 (37.5)||0.22|
|Rejection after CMV, n (%)||0/4 (0)||1/8 (12.5)||<0.001|
|Readmission for CMV, n (%)||1/4 (25)||2/8 (25)||0.14|
|Median viral load||809.5||1066.5||0.19|
Conclusions: A high rate of CMV-R was found in this R+ HTR population, and use of STER/VAC prophylaxis led to early reactivation and increased rejection. This is the first study to evaluate CMV-R specifically in the R+ HTR population, and reinforces the need for aggressive CMV prophylaxis regardless of induction strategy utilized.
To cite this abstract in AMA style:Liu E, Doligalski C. Does Prophylaxis Strategy Matter? CMV Reactivation in Moderate Risk (R+) Heart Transplant Recipients [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/does-prophylaxis-strategy-matter-cmv-reactivation-in-moderate-risk-r-heart-transplant-recipients/. Accessed May 5, 2021.
« Back to 2015 American Transplant Congress