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Assessment of Risk Factors for Cytomegalovirus DNAemia after Termination of Regular Prophylaxes after Heart Transplantation.
- Source :
-
Journal of Heart & Lung Transplantation . 2023 Supplement, Vol. 42, pS292-S293. 2p. - Publication Year :
- 2023
-
Abstract
- 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]
Details
- Language :
- English
- ISSN :
- 10532498
- Volume :
- 42
- Database :
- Academic Search Index
- Journal :
- Journal of Heart & Lung Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 162849755
- Full Text :
- https://doi.org/10.1016/j.healun.2023.02.670