Cytomegalovirus mismatch after heart transplantation: Impact of antiviral prophylaxis and intravenous hyperimmune globulin.

OBJECTIVE

Cytomegalovirus (CMV) infections are correlated with complications following heart transplantation (HTx) and impaired outcome. The impact of a serologic mismatch between donor and recipient and the necessity of prophylactic virostatic medication is still a matter of concern.

METHODS

We retrospectively reviewed all patients that underwent HTx between 2010 and 2020 in our department. The recipients (n = 176) could be categorized into four risk groups depending on their serologic CMV matching (D+ /R-  = donor CMV-IgG positive and recipient CMV-IgG negative, n = 32; D- /R+ , n = 51; D- /R- , n = 35; D+ /R+ , n = 58). All patients followed the same protocol of CMV prophylaxis with application of ganciclovir/valganciclovir and intravenous CMV hyperimmune globulin.

RESULTS

Incidence of postoperative morbidity such as primary graft dysfunction, neurological events, infections, and graft rejection were comparable between all groups (p > .05). However, the incidence of postoperative acute kidney injury with hemodialysis was by trend increased in the D- /R+ group (72.0%) compared to the other groups. In-hospital CMV-DNAemia was observed in serologic positive recipients only (D+ /R- : 0.0%, D- /R+ : 25.0%, D- /R- : 0.0%, D+ /R+ : 13.3%, p < .01). During the first year, a total of 18 patients developed CMV-DNAemia (D+ /R- : 31.6%, D- /R+ : 31.9%, D- /R- : 3.4%, D+ /R+ : 11.1%, p = .03).

CONCLUSIONS

Seropositive recipients carry an important risk for CMV-DNAemia. However, we did not observe differences in perioperative morbidity and mortality regarding CMV matching, which might be related to regularly administer prophylactic virostatics and additional CMV-IVIG for risk constellations. For high-risk constellation, long-term application of CMV-IVIG during the first year after transplant may be beneficial.