Cytomegalovirus mismatch after heart transplantation: Impact of antiviral prophylaxis and intravenous hyperimmune globulin

Abstract Objective Cytomegalovirus (CMV) infections are correlated with complications following heart transplantation (HTx) and impaired outcome. The impact of a serologic mismatch between donor and recipient and the necessity of prophylactic virostatic medication is still a matter of concern. Metho...

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Autores principales:	Moritz B. Immohr, Payam Akhyari, Charlotte Böttger, Arash Mehdiani, Hannan Dalyanoglu, Ralf Westenfeld, Daniel Oehler, Igor Tudorache, Hug Aubin, Artur Lichtenberg, Udo Boeken
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	CMV‐DNAemia cytomegalovirus ganciclovir heart transplantation intravenous hyperimmune globulin valganciclovir Immunologic diseases. Allergy RC581-607
Acceso en línea:	https://doaj.org/article/a29d51d221ff4f22be39a91b85f1d241
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spelling	oai:doaj.org-article:a29d51d221ff4f22be39a91b85f1d2412021-11-12T19:57:15ZCytomegalovirus mismatch after heart transplantation: Impact of antiviral prophylaxis and intravenous hyperimmune globulin2050-452710.1002/iid3.508https://doaj.org/article/a29d51d221ff4f22be39a91b85f1d2412021-12-01T00:00:00Zhttps://doi.org/10.1002/iid3.508https://doaj.org/toc/2050-4527Abstract Objective Cytomegalovirus (CMV) infections are correlated with complications following heart transplantation (HTx) and impaired outcome. The impact of a serologic mismatch between donor and recipient and the necessity of prophylactic virostatic medication is still a matter of concern. Methods We retrospectively reviewed all patients that underwent HTx between 2010 and 2020 in our department. The recipients (n = 176) could be categorized into four risk groups depending on their serologic CMV matching (D+/R− = donor CMV‐IgG positive and recipient CMV‐IgG negative, n = 32; D−/R+, n = 51; D−/R−, n = 35; D+/R+, n = 58). All patients followed the same protocol of CMV prophylaxis with application of ganciclovir/valganciclovir and intravenous CMV hyperimmune globulin. RESULTS Incidence of postoperative morbidity such as primary graft dysfunction, neurological events, infections, and graft rejection were comparable between all groups (p > .05). However, the incidence of postoperative acute kidney injury with hemodialysis was by trend increased in the D−/R+ group (72.0%) compared to the other groups. In‐hospital CMV‐DNAemia was observed in serologic positive recipients only (D+/R−: 0.0%, D−/R+: 25.0%, D−/R−: 0.0%, D+/R+: 13.3%, p < .01). During the first year, a total of 18 patients developed CMV‐DNAemia (D+/R−: 31.6%, D−/R+: 31.9%, D−/R−: 3.4%, D+/R+: 11.1%, p = .03). Conclusions Seropositive recipients carry an important risk for CMV‐DNAemia. However, we did not observe differences in perioperative morbidity and mortality regarding CMV matching, which might be related to regularly administer prophylactic virostatics and additional CMV‐IVIG for risk constellations. For high‐risk constellation, long‐term application of CMV‐IVIG during the first year after transplant may be beneficial.Moritz B. ImmohrPayam AkhyariCharlotte BöttgerArash MehdianiHannan DalyanogluRalf WestenfeldDaniel OehlerIgor TudoracheHug AubinArtur LichtenbergUdo BoekenWileyarticleCMV‐DNAemiacytomegalovirusganciclovirheart transplantationintravenous hyperimmune globulinvalganciclovirImmunologic diseases. AllergyRC581-607ENImmunity, Inflammation and Disease, Vol 9, Iss 4, Pp 1554-1562 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	CMV‐DNAemia cytomegalovirus ganciclovir heart transplantation intravenous hyperimmune globulin valganciclovir Immunologic diseases. Allergy RC581-607
spellingShingle	CMV‐DNAemia cytomegalovirus ganciclovir heart transplantation intravenous hyperimmune globulin valganciclovir Immunologic diseases. Allergy RC581-607 Moritz B. Immohr Payam Akhyari Charlotte Böttger Arash Mehdiani Hannan Dalyanoglu Ralf Westenfeld Daniel Oehler Igor Tudorache Hug Aubin Artur Lichtenberg Udo Boeken Cytomegalovirus mismatch after heart transplantation: Impact of antiviral prophylaxis and intravenous hyperimmune globulin
description	Abstract Objective Cytomegalovirus (CMV) infections are correlated with complications following heart transplantation (HTx) and impaired outcome. The impact of a serologic mismatch between donor and recipient and the necessity of prophylactic virostatic medication is still a matter of concern. Methods We retrospectively reviewed all patients that underwent HTx between 2010 and 2020 in our department. The recipients (n = 176) could be categorized into four risk groups depending on their serologic CMV matching (D+/R− = donor CMV‐IgG positive and recipient CMV‐IgG negative, n = 32; D−/R+, n = 51; D−/R−, n = 35; D+/R+, n = 58). All patients followed the same protocol of CMV prophylaxis with application of ganciclovir/valganciclovir and intravenous CMV hyperimmune globulin. RESULTS Incidence of postoperative morbidity such as primary graft dysfunction, neurological events, infections, and graft rejection were comparable between all groups (p > .05). However, the incidence of postoperative acute kidney injury with hemodialysis was by trend increased in the D−/R+ group (72.0%) compared to the other groups. In‐hospital CMV‐DNAemia was observed in serologic positive recipients only (D+/R−: 0.0%, D−/R+: 25.0%, D−/R−: 0.0%, D+/R+: 13.3%, p < .01). During the first year, a total of 18 patients developed CMV‐DNAemia (D+/R−: 31.6%, D−/R+: 31.9%, D−/R−: 3.4%, D+/R+: 11.1%, p = .03). Conclusions Seropositive recipients carry an important risk for CMV‐DNAemia. However, we did not observe differences in perioperative morbidity and mortality regarding CMV matching, which might be related to regularly administer prophylactic virostatics and additional CMV‐IVIG for risk constellations. For high‐risk constellation, long‐term application of CMV‐IVIG during the first year after transplant may be beneficial.
format	article
author	Moritz B. Immohr Payam Akhyari Charlotte Böttger Arash Mehdiani Hannan Dalyanoglu Ralf Westenfeld Daniel Oehler Igor Tudorache Hug Aubin Artur Lichtenberg Udo Boeken
author_facet	Moritz B. Immohr Payam Akhyari Charlotte Böttger Arash Mehdiani Hannan Dalyanoglu Ralf Westenfeld Daniel Oehler Igor Tudorache Hug Aubin Artur Lichtenberg Udo Boeken
author_sort	Moritz B. Immohr
title	Cytomegalovirus mismatch after heart transplantation: Impact of antiviral prophylaxis and intravenous hyperimmune globulin
title_short	Cytomegalovirus mismatch after heart transplantation: Impact of antiviral prophylaxis and intravenous hyperimmune globulin
title_full	Cytomegalovirus mismatch after heart transplantation: Impact of antiviral prophylaxis and intravenous hyperimmune globulin
title_fullStr	Cytomegalovirus mismatch after heart transplantation: Impact of antiviral prophylaxis and intravenous hyperimmune globulin
title_full_unstemmed	Cytomegalovirus mismatch after heart transplantation: Impact of antiviral prophylaxis and intravenous hyperimmune globulin
title_sort	cytomegalovirus mismatch after heart transplantation: impact of antiviral prophylaxis and intravenous hyperimmune globulin
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/a29d51d221ff4f22be39a91b85f1d241
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Cytomegalovirus mismatch after heart transplantation: Impact of antiviral prophylaxis and intravenous hyperimmune globulin

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