Background: Cytomegalovirus (CMV) has been associated with the subsequent development of cardiac allograft vasculopathy (CAV) after heart transplantation. In the more recent era, CMV has been seen less due to antibiotic prophylaxis and changes in maintenance immunosuppression regimens. To assess whether CMV continues to have an impact on CAV, we chose to assess patients with first-year CMV syndrome/disease (clinically evident CMV infection) and the subsequent development of intimal thickening as observed by intravascular ultrasound.

Methods: Between 2010 and 2014 we evaluated 458 heart transplant patients during the first year after heart transplantation. Patients with clinically evident CMV syndrome and/or specific organ involvement were noted. These patients were compared to patients transplanted in the same era who did not have first year clinically relevant CMV infection. All patients underwent first-year intravascular ultrasound at baseline (4-6 weeks after heart transplant) and at 12 months. The change in maximal intimal thickness (MIT) was obtained in all patients.

Results: The demographics between the two groups did not show significant difference for the following: mean recipient age, mean donor age, body mass index, percent female, cold ischemic time, status 1 at heart transplantation, diabetes, treated hypertension, pre-transplant PRA ≥ 10%, anti-thymocyte globulin (ATG) induction. All patients were treated with tacrolimus, mycophenolate mofetil, and corticosteroids as maintenance immunosuppression. The first-year change in MIT between both patient groups was not significantly different. See table.Conclusion: CMV in the current era does not appear to be associated with the development of intimal thickening in the first year after heart transplantation. Longer follow-up may be needed to confirm this observation.

CITATION INFORMATION: Leong D, Azarbal B, Patel J, Kittleson M, Czer L, Aintablian T, Chang D, Geft D, Kobashigawa J. In the Modern Era, Cytomegalovirus Does Not Appear to Increase Intimal Thickening After Heart Transplantation. Am J Transplant. 2017;17 (suppl 3).

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