Long-term impact of cytomegalovirus serologic status on lung transplantation in the United States

BACKGROUND: Cytomegalovirus (CMV) infection has been associated with poor outcomes following solid organ transplantation. However, the long-term impact of donor and recipient CMV serological status on lung transplant outcomes remains unclear. Accordingly, we evaluated the impact of donor and recipient CMV status on long-term patient as well as allograft survival following single (SLT) and double lung transplantation (BLT). METHODS: The Scientific Registry of Transplant Recipients was used to track all adult lung transplants in United States from May 2005 to June 2016. Patient mortality and bronchiolitis obliterans syndrome were determined up to 5 years using Cox proportional hazards modeling. Additionally, landmark analysis was performed conditional on survival at 1-year. RESULTS: Compared to donor negative-recipient CMV-IgG negative (D-R-), donor positive–recipient negative (D+R-) and donor positive-recipient positive (D+R+) groups had increased mortality at 1- and 5-years following BLT with the former demonstrating highest risk. While mortality was not increased with CMV seropositive donors following SLT at 1-year, both (D+R-) and (D+R+) groups demonstrated greater mortality at 5-year. Risk of bronchiolitis obliterans syndrome was not affected by CMV serological status. Conditional landmark analysis confirmed that lungs from CMV seropositive donors conferred highest risk for long-term mortality. CONCLUSIONS: CMV seronegative recipients undergoing either BLT or SLT from CMV seropositive donors have the highest risk of long-term mortality which extends beyond the first year. Further studies are needed to determine the causes of higher mortality observed in the CMV seronegative recipients and risks benefits of extension of CMV prophylaxis, particularly in the high-risk group.