Increasing Proportion of High-risk Cytomegalovirus Donor-positive/Recipient-negative Serostatus in Solid Organ Transplant Recipients

Abstract

Background. Cytomegalovirus (CMV) donor-positive/recipient-negative (D+R–) serostatus is independently associated with worse allograft and patient survival across solid organ transplant (SOT) types. We characterized trends in CMV D+R– serostatus among adult SOT recipients performed in the United States. Methods. Donor (D) and recipient (R) CMV serostatus and demographic factors were obtained from the Scientific Registry of Transplant Recipients for persons ≥18 y undergoing a first SOT between January 1, 2000, and December 31, 2020. The proportions of D+R– SOTs over time were assessed using Chi square for trend and modeled through 2040. Factors associated with D/R seropositivity were assessed using logistic models. Results. Among 472 549 SOTs, the average proportion of D+R– SOTs increased significantly among kidney, liver, heart, and lung between 2000 to 2009 and 2010 to 2020: 18.0% to 18.3% (P = 0.034), 19.4% to 21.8% (P < 0.001), 22.2% to 25.5% (P < 0.001), and 23.6% to 27.0% (P < 0.001), respectively. The increased proportion over time resulted from a disproportionate increase in R– (34.9% to 37.0% for all organ types, P < 0.001) and a smaller corresponding change in D+ (60.8% to 60.3%, P < 0.001). Conclusions. The proportion of high-risk CMV D+R– SOTs increased significantly across all organs and is projected to continue to increase. These findings inform population-level strategies to mitigate the negative impact of CMV D+R– in SOT.

A practical guide to real‐world implementation of pre‐emptive therapy for Cytomegalovirus disease prevention in high‐risk seronegative liver transplant recipients with seropositive donors

“…Centers where PET is not currently used for any population may choose to adopt PET for both D + R − and R + LTRs simultaneously, while others may focus initial PET implementation efforts exclusively on one population. Approximately 20% of all liver recipients in the United States are CMV D + R − , which translates into approximately two CMV D + R − transplants per month (∼24 transplants/year) at a mid‐to‐large‐sized transplant center, or one to two transplants per quarter (∼5–15 transplants/year) at lower volume centers 11 . Focusing initial PET implementation exclusively on the relatively small CMV D + R − population may be less daunting and more feasible, and targets the specific population in whom PET was statistically superior to prophylaxis in the CAPSIL study.…”

What’s New: Updates on Cytomegalovirus in Solid Organ Transplantation

“…The proportion of D+/R− patients appears to be increasing in some regions. 12 The Scientific Registry of Transplant Recipients collects US data on donor and recipient CMV serostatus. Among deceased donor kidney transplants, the proportion of D+/R− patients in the United States was ~18% between 2005 and 2019.…”

Cytomegalovirus High-risk Kidney Transplant Recipients Show No Difference in Long-term Outcomes Following Preemptive Versus Prophylactic Management

“…9 The proportion of CMV high-risk solid organ transplant recipients is increasing, and it is projected to continue to increase. 23 The third international consensus guidelines on the management of CMV in solid organ transplantation state that there is a need for more data on preemptive versus prophylactic management of CMV high-risk recipients to establish whether one strategy is superior to the other. 8 To answer the call for data, we have conducted a retrospective nationwide registry-based analysis of long-term outcomes, as well as the frequency of, and time to first active CMV infection in the entire cohort of CMV highrisk and CMV intermediate-risk Norwegian kidney recipients transplanted between 2007 and 2018.…”