Impact of donor and recipient cytomegalovirus serology on long‐term survival of heart transplant recipients

Mabilangan, Curtis; Preiksaitis, Jutta K.; Cervera, Carlos

doi:10.1111/tid.13015

Cited by 8 publications

(6 citation statements)

References 20 publications

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“…While a number of adult studies have evaluated the role of CMV infection on CAV and graft rejection among HTx recipients, few studies have explored the impact of CMV risk status on infection, recurrence, and rejection in the setting of prophylactic VGC among children 10,23,24 . While we observed no difference in overall rejection, CAV or survival among CMV risk‐stratified children, time to first rejection episode was significantly shorter among HR (D + R−) HTx recipients as compared to IR (R+) and LR (D−R−) recipients, despite 6 months of VGC prophylaxis.…”

Section: Discussioncontrasting

confidence: 58%

Cytomegalovirus infection and allograft rejection among pediatric heart transplant recipients in the era of valganciclovir prophylaxis

Das

Prusty

Niu

et al. 2020

Pediatric Transplantation

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CMV remains a well-recognized cause of morbidity among HTx recipients and is associated with both direct and indirect effects following transplantation. 1-5 CMV discordant (D+/R−) recipients remain at HR for CMV infection and disease following transplant, followed by CMV (R+) and (D−R−) recipients, respectively. While current guidelines outline describe a number of potential CMV management strategies following SOT including antiviral prophylaxis, preemptive therapy, and hybrid approaches, universal antiviral prophylaxis is recommended for HR CMV discordant (D+/R−) HTx recipients. 2 VGC, an oral prodrug of ganciclovir, is widely used following HTx and has been shown to decrease CMV infection and disease among adult HTx recipients. 6-9 Yet few studies to date have explored the burden

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Section: Discussioncontrasting

confidence: 58%

Cytomegalovirus infection and allograft rejection among pediatric heart transplant recipients in the era of valganciclovir prophylaxis

Das

Prusty

Niu

et al. 2020

Pediatric Transplantation

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“…Across the selected countries, most studies reported rates of CMV infection (ranging from 5.2% to 63.2% within 1 year posttransplant) and CMV disease (up to 19%) (Figure S4), which were consistent with those found in Europe and North America where reported rates ranged respectively, between 7.5% and 65.4% (31 studies) 61–91 and between 0.9% and 23.4% (22 studies) 62–65,68–71,76,79–83,87,89–90,92–96 . In this review, a trend toward lower rates of CMV infection was observed in kidney and liver recipients treated with ganciclovir or valganciclovir as CMV prophylaxis (5.2%–20.6%, n = 5 studies) compared to those only managed with preemptive monitoring (from 25.7% to 50.2%, n = 11 studies).…”

Section: Discussionsupporting

confidence: 83%

Epidemiology, management, and burden of cytomegalovirus in solid organ transplant recipients in selected countries outside of Europe and North America: A systematic review

Silva

Tokat

Cai

et al. 2023

Transplant Infectious Dis

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BackgroundCytomegalovirus (CMV) is a frequent infectious complication following solid organ transplantation (SOT). Considering significant differences in healthcare systems, a systematic review was conducted to describe the epidemiology, management, and burden of CMV post‐SOT in selected countries outside of Europe and North America.MethodsMEDLINE, Embase, and Cochrane databases were searched for observational studies in SOT recipients across 15 countries in the regions of Asia, Pacific, and Latin America (search period: January 1, 2011 to September 17, 2021). Outcomes included incidence of CMV infection/disease, recurrence, risk factors, CMV‐related mortality, treatment patterns and guidelines, refractory and/or resistant CMV, patient‐reported outcomes, and economic burden.ResultsOf 2708 studies identified, 49 were eligible (n = 43/49; 87.8% in adults; n = 34/49, 69.4% in kidney recipients). Across studies, selection of CMV preventive strategy was based on CMV serostatus. Overall, rates of CMV infection (within 1 year) and CMV disease post‐SOT were respectively, 10.3%–63.2% (9 studies) and 0%–19.0% (17 studies). Recurrence occurred in 35.4%–41.0% cases (3 studies) and up to 5.3% recipients died of CMV‐associated causes (11 studies). Conventional treatments for CMV infection/disease included ganciclovir (GCV) or valganciclovir. Up to 4.4% patients were resistant to treatment (3 studies); no studies reported on refractory CMV. Treatment‐related adverse events with GCV included neutropenia (2%–29%), anemia (13%–48%), leukopenia (11%–37%), and thrombocytopenia (13%–24%). Data on economic burden were scarce. imageConclusionOutside of North America and Europe, rates of CMV infection/disease post‐SOT are highly variable and CMV recurrence is frequent. CMV resistance and treatment‐associated adverse events, including myelosuppression, highlight unmet needs with conventional therapy.

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“…Several studies reported that donor and/or recipient CMV serology alone was associated with a higher risk of mortality among HSCT [ 38 , 39 ] and SOT patients [ 31 , 40 , 41 ]. On the other hand, Mabilangan et al [ 42 , 43 ] found no association between donor/recipient CMV serology and 10 years mortality among heart or lung transplant recipients. One potential explanation for the similar survival rates of CMV and non-CMV patients in our study may be the limited follow-up time of 1 year, which is comparatively shorter than other analyses of survival which reported outcomes based on extended follow-up periods of 5 years or longer [ 34 – 36 , 39 , 41 ].…”

Section: Discussionmentioning

confidence: 99%

Cytomegalovirus infection and rehospitalization rates after allogeneic hematopoietic stem cell and solid organ transplantation: a retrospective cohort study using German claims data

et al. 2022

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Purpose This study aimed to describe the cytomegalovirus (CMV) infection rate, rehospitalizations, and comorbidities following allogeneic hematopoietic stem cell transplantation (allo-HSCT) and solid organ transplantation (SOT). Methods Patients who received allo-HSCT or SOT in 01/07/2015–30/06/2018 were identified using anonymized German claims data. The transplantation-related hospital admission date was defined as the index date, and patients were followed for up to 12 months (or death, first event relevant). The frequency of CMV infections (confirmed outpatient/inpatient diagnoses, ICD-10-GM codes: B25.-/B27.1) and the rate, number, and duration of all-cause rehospitalizations in the follow-up period were evaluated. Results A total of 226 allo-HSCT and 250 SOT patients were identified (mean age 52.8 years, 38.9% female). During the 12 months after transplantation, 29.2% of allo-HSCT patients and 16.8% of SOT patients received a CMV diagnosis. The majority of these diagnoses were given during the initial hospitalization or within the following 3 months. Across transplantation types, CMV patients had more hospital readmission days per patient-year (allo-HSCT 93.3 vs. 49.4, p = 0.001; SOT 42.0 vs. 20.7, p = 0.005), with a longer mean duration of readmissions (allo-HSCT 22.4 vs. 15.4 days, p < 0.001; SOT 11.6 vs. 7.5 days, p = 0.003). Comorbidity burden in transplantation patients was substantial, with several diagnoses being significantly more common among patients with CMV vs. non-CMV. One-year mortality did not differ significantly between patients with/without CMV. Conclusion Burden of transplant recipients with CMV in terms of rehospitalizations and comorbidities is substantial, highlighting the need for improved CMV prevention and treatment.

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Impact of donor and recipient cytomegalovirus serology on long‐term survival of heart transplant recipients

Cited by 8 publications

References 20 publications

Cytomegalovirus infection and allograft rejection among pediatric heart transplant recipients in the era of valganciclovir prophylaxis

Cytomegalovirus infection and allograft rejection among pediatric heart transplant recipients in the era of valganciclovir prophylaxis

Epidemiology, management, and burden of cytomegalovirus in solid organ transplant recipients in selected countries outside of Europe and North America: A systematic review

Cytomegalovirus infection and rehospitalization rates after allogeneic hematopoietic stem cell and solid organ transplantation: a retrospective cohort study using German claims data

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