Increasing Proportion of High-Risk Cytomegalovirus (CMV) Donor Positive/recipient Negative (D+R-) Serostatus in Solid Organ Transplant Recipients (SOTRs)

H. Imlay¹, M. M. Wagener², N. Singh², A. P. Limaye³

¹University of Utah, Salt Lake City, UT, ²University of Pittsburgh, Pittsburgh, PA, ³University of Washington, Seattle, WA

Meeting: 2022 American Transplant Congress

Abstract number: 965

Keywords: Cytomeglovirus, High-risk, Organ Selection/Allocation

Topic: Clinical Science » Infection Disease » 24 - All Infections (Excluding Kidney & Viral Hepatitis)

Session Information

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

Session Type: Poster Abstract

Date: Sunday, June 5, 2022

Session Time: 7:00pm-8:00pm

Presentation Time: 7:00pm-8:00pm

Location: Hynes Halls C & D

*Purpose: CMV D+R- serostatus is independently associated with worse long-term graft and patient survival across many organ transplant types despite current prevention and treatment strategies. Thus, allocation policies (serosorting) to reduce the proportion of CMV D+R- SOTR are being considered. The objectives of this study were to characterize trends in CMV D+R- serostatus among adult organ transplants (SOTs) performed in the United States and to project the proportion of D+R- SOTs in the future.

*Methods: Donor and recipient CMV serostatus and demographic factors previously associated with CMV seropositivity were obtained from the Scientific Registry of Transplant Recipients (SRTR) from 1/1/2000-12/31/2020 for persons ≥18 years undergoing a first SOT. Differences in proportion of D+R- SOTR over time were assessed using chi square for trend. Linear models using the last 10 years were used to model future D+R- status.

*Results: A total of 525,852 SOTs were performed during the study period; 207,510 between 2000-2009 and 318,342 between 2010-2020. The average proportion of CMV D+R- SOTs was stable among kidney recipients and substantively increased among liver, heart, and lung recipients between 2000-2009 and 2010-2020: 17.6% to 17.9% in kidney (p=0.009), 19.2% to 21.5% (p<0.001) in liver, 22.0 to 25.1% in heart (p<0.001), and 23.4% to 26.6% in lung (p<0.001). The increased proportion of CMV D+R- SOTs over time was due primarily to a disproportionate increase in R- status (34% to 36%, p<0.001) without a corresponding increase in D+ donors (60.8% to 60.1%, p<0.001). The projected proportion of CMV D+R- SOTs by 2040 is estimated to be 19.1% in kidney (95% CI 18.5-19.6), 26.3% in liver (95% CI 25.1-27.6), 30.3% in heart (95% CI 28.8-31.9), and 32.1% in lung (95% CI 30.3-33.9) SOTRs.

*Conclusions: There was a significant increase in the proportion of CMV D+R- SOTs across all organs from 2000 to 2020 and there is a projected continued increase over the next 20 years if current trends continue. These changes should inform serosorting-based allocation strategies and prioritize approaches to mitigate the negative impact of CMV D+R- on SOTR outcomes.

To cite this abstract in AMA style:

Imlay H, Wagener MM, Singh N, Limaye AP. Increasing Proportion of High-Risk Cytomegalovirus (CMV) Donor Positive/recipient Negative (D+R-) Serostatus in Solid Organ Transplant Recipients (SOTRs) [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/increasing-proportion-of-high-risk-cytomegalovirus-cmv-donor-positive-recipient-negative-dr-serostatus-in-solid-organ-transplant-recipients-sotrs/. Accessed May 6, 2025.

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