*Purpose: Current assessment of risk of Cytomegalovirus (CMV) infection in CMV+ heart transplant (HT) recipients is poor. A diminished CMV-specific T cell response against 2 CMV antigens (IE-1 and pp65), using the IFN-γ ELISPOT, is associated with higher risk of developing CMV infection after HT. However we do not know the reasons for this diminished CMV-specific T cell response. We aimed to evaluate predictors of intermediate or high risk of developing CMV infection according to the IFN-γ ELISPOT at the time of HT.

*Methods: We prospectively evaluated all CMV+ HT recipients in one institution from 2017 until present in whom we performed an IFN-γ ELISPOT on the day of HT. Patients were classified into low risk (IE-1>23 spots and pp65>79 spots) and not low risk: Intermediate (IE-1<23 spots or pp65<79 spots), high (IE-1<23 spots and pp65<79 spots) or anergic. Baseline variables are presented as median and IQR or number(%). We determined predictors of not low risk for developing CMV infection using binary logistic regression. Variables that had a univariate p<0.2 were included in the multivariate analysis.

*Results: We included 26 CMV+ HT recipients of which 14 had low risk ELISPOT and 12 not low risk ELISPOT (4 intermediate, 6 high and 2 anergic). Variables closer to HT according to the ELISPOT group are presented in the table. We included left ventricular ejection fraction (LVEF), MELD score and NTproBNP value in the multivariate analysis but none of them significantly predicted a not low risk ELISPOT.

*Conclusions: More advance heart failure before HT may be associated with a higher risk of CMV infection in CMV positive recipients. We need bigger numbers to confirm this tendency.

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