Impact of Cytomegalovirus Mismatch on Outcome after Heart Transplantation

Objectives: Cytomegalovirus (CMV) is correlated with several complications following heart transplantation (HTx) and thereby represents a key factor for impaired outcome. The impact of a serologic mismatch between donor and recipient is still controversially discussed. Especially the necessity of prophylactic virostatic medication is a matter of concern. Therefore, we aimed to analyze the impact of preoperative CMV matching on perioperative morbidity and mortality after HTx.

Methods: We retrospectively reviewed all 166 patients, which underwent HTx between 2010 and 2020 in our department. Patients were divided with regard to their pretransplant CMV matching. The recipients could be categorized into 4 groups depending on their serologic CMV matching (Group 1: donor and recipient CMV-IgG positive (= D+/R+), n = 50; Group 2: (D+/R−), n = 29; Group 3: (D−/R+), n = 44; Group 4: (D−/R−), n = 32). The remaining patients were excluded due to missing information about the donors CMV status. Patients and donors were comparable concerning co-morbidities and risk factors for impaired posttransplant outcome.

Result: Incidence of primary graft dysfunction (PGD), perioperative neurological events, bleeding complications, severe infections and early graft rejection (>1R) were comparable between all groups (p < 0.05). In contrast, the incidence of postoperative acute kidney injury with need for hemodialysis was significantly increased in Group 3 (74.4%) compared with the other groups (56.3% in Group 1, 39.3% in Group 2, and 48.4% in Group 4, p = 0.03). Posttransplant CMV viremia was observed in serologic positive recipients only (Group 1: 13.3%, Group 2: 0.0%, Group 3: 25.0%, and Group 4: 0.0%, p < 0.01). The 30-day and 1-year survival did not differ between the four groups.

Conclusion: Except for kidney function, we did not observe any differences in perioperative morbidity and mortality regarding CMV matching in our cohort. Seropositive recipients carry the most important risk factor of posttransplant CMV viremia. In contrast, the so-called “high-risk” CMV configuration (D+/R−) showed no impairments of postoperative outcome compared with “low-risk” (D−/R−), which may be related to positive effects of regularly administered prophylactic virostatic medication in the “high-risk” cohort.

Publication History

Article published online:
19 February 2021