Search

Background: Cytomegalovirus (CMV) infections after heart transplantation (HTx) can cause cardiac allograft vasculopathy. Consequently, monitoring and prophylaxis for cytomegalovirus deoxyribonucleic acid (CMV-DNAemia) within the first weeks after HTx is recommended., Methods: All patients who underwent HTx between September 2010 and 2021 surviving the first 90 days (n = 196) were retrospectively reviewed. The patients were divided on the prevalence of CMV-DNAemia during the first postoperative year after the end of the prophylaxis. A total of n = 35 (20.1%) developed CMV-DNAemia (CMV group) and were compared to patients without CMV-DNAemia (controls, n = 139). The remaining patients (n = 22) were excluded due to incomplete data., Results: Positive donors and negative recipients (D+/R-) and negative donors and positive recipients (D-/R+) serology was significantly increased and D-/R- decreased in the CMV group (p < .01). Furthermore, the mean age was 57.7 ± 8.7 years but only 53.6 ± 10.0 years for controls (p = .03). Additionally, the intensive care unit (p = .02) and total hospital stay (p = .03) after HTx were approximately 50% longer. Interestingly, the incidence of CMV-DNAemia during prophylaxis was only numerically increased in the CMV group (5.7%, respectively, 0.7%, p = .10), the same effect was also observed for postoperative infections. Multivariate analyses confirmed that D+/R- and D-/R+ CMV immunoglobulin G match were independent risk factors for postprophylaxis CMV-DNAemia., Conclusion: Our data should raise awareness of CMV-DNAemia after the termination of regular prophylaxis, as this affects one in five HTx patients. Especially old recipients as well as D+/R- and D-/R+ serology share an elevated risk of late CMV-DNAemia. For these patients, prolongation, or repetition of CMV prophylaxis, including antiviral drugs and CMV immunoglobulins, may be considered., (© 2023 The Authors. Immunity, Inflammation and Disease published by John Wiley & Sons Ltd.)

This article discusses the incidence and risk factors for malignancies in patients who have undergone heart transplantation at a single center. The study analyzed data from 296 patients who had undergone heart transplantation between September 2010 and August 2023. The overall incidence of malignancy was 8.8%, with skin cancer being the most common type. The study found that the switch to everolimus as part of the immunosuppression therapy did not reduce the incidence of malignancies. Early detection through close follow-up is important for improving the prognosis of these malignancies. [Extracted from the article]

Cytomegalovirus (CMV) infections after heart transplantation (HTx) can cause development of cardiac allograft vasculopathy (CAV). Consequently, frequent monitoring and prophylaxes for CMV-DNAemia within the first weeks after HTx is regularly performed. However, CMV-DNAemia after termination of the perioperative prophylaxes is commonly observed. All adult patients undergoing HTx between September of 2010 and 2021 surviving the first 90 days (n=196) were retrospectively reviewed in September 2022. Patients were divided regarding the prevalence of CMV-DNAemia during the first postoperative year after termination of the institutional 90-day CMV prophylaxis. A total of n=35 (20.1%) developed CMV-DNAemia (CMV group) and were compared to patients without CMV-DNAemia (Controls, n=139). The remaining patients (n=22) were excluded due to incomplete data. CMV prophylaxis consisted of val-/ganciclovir as well as intravenous CMV immunoglobulin for high-risk D+/R- CMV IgG match. D+/R- and D-/R+ serology was significantly increased and D-/R- decreased in the CMV group (p<.01). In addition, mean age was 57.7±8.7 years but only 53.6±10.0 years for Controls (p=.03). Furthermore, ICU (p=.02) and total hospital stay (p=.03) after HTx was about 50% longer compared to the controls. Interestingly, incidence of CMV-DNAemia during the regular prophylaxis was only numerically increased in the CMV group (5.7% respectively.7%, p=.10), the same effect was also overserved for postoperative infective complications. Multivariate analyses could confirm that increased recipient age and D+/R- and D-/R+ CMV IgG match of donors and recipients were independent risk factors for post-prophylaxis CMV-DNAemia within the first year after heart transplantation. Our data should raise awareness for CMV-DNAemia after termination of regular prophylaxis schemes, as this affects one of five HTx patients and can contribute to the development of CAV. Especially old recipients as well as D+/R- and D-/R+ serology share an elevated risk for late CMV-DNAemia. For these patients, prolongation or repetition of CMV prophylaxis including antiviral drugs and CMV immunoglobulins may be considered. [ABSTRACT FROM AUTHOR]

Immunosuppression after Heart transplantation (HTx) carries a life-long risk for infection and reactivation of herpesviridae. Especially changes in the immunosuppressive therapy regime can promote viral reactivation. Infections with SARS-CoV-2 can also alter the immune response. However, potential effects on herpesviridae reactivation still needs to be examined in this context. Since emerge of the COVID-19 pandemic in the early 2020, n=61 of our HTx or heart and kidney transplant (HKTx) patients had positive polymerase chain reaction (PCR) for SARS-CoV-2. Relevant patient data including results for potential concomitant herpes simplex virus (HSV-1, HSV-2), cytomegalovirus (CMV), Epstein-Barr-virus (EBV), varicella zoster virus (CZV) and human herpesvirus-8 (HHV-8) DNAemia were retrospectively reviewed in September 2022 to evaluate its clinical impact. Most patients have received at least one and up to six doses of COVID-19 vaccine before contracting SARS-CoV-2. In general, HTx and HKTx patients developed symptomatic but mild COVID-19, which was most likely caused by any kind of omicron subvariant. SARS-CoV-2 positive HTx and HKTx patients were pharmacologically treated for COVID-19. DNAemia of herpesviridae was examined in about one third of the patients (n=20). HSV-1 DNAemia was confirmed in 6.25% of tested patients with a maximum viral load of 1,130,000 HSV-1-DNA copies/µg-DNA. In not a single patient HSV-2, VZV and HHV-8 DNA was found. In contrast, CMV was observed in 20% of tested patients with a maximum of 195 CMV-DNA copies/µg-DNA and EBV in 23.5% (maximum 1230 EBV-DNA copies/µg-DNA). In one patient simultaneous CMV- and EBV-DNAemia and in another patient EBV- and HSV-1-DNAemia were found. Nevertheless, none of these patients developed clinically relevant infection or reactivation of herpesviridae and therefore no targeted treatment was initiated. Recently, SARS-CoV-2 infections are commonly observed in patients after HTx and HKTx. Fortunately, patients rarely suffer from severe COVID-19-related symptoms. Meanwhile, concomitant infections or reactivation of herpesviridae, especially CMV and EBV, are regularly observed. Although we did not overserved CMV or EBV disease, regularly testing for herpesviridae seems reasonable in these patients. [ABSTRACT FROM AUTHOR]