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...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-12-01
|
| Series: | Immunity, Inflammation and Disease |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/iid3.508 |
| _version_ | 1819003240639889408 |
|---|---|
| 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 |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-12-20T23:17:52Z |
| format | Article |
| id | doaj.art-a29d51d221ff4f22be39a91b85f1d241 |
| institution | Directory Open Access Journal |
| issn | 2050-4527 |
| language | English |
| last_indexed | 2024-12-20T23:17:52Z |
| publishDate | 2021-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Immunity, Inflammation and Disease |
| spelling | doaj.art-a29d51d221ff4f22be39a91b85f1d2412022-12-21T19:23:36ZengWileyImmunity, Inflammation and Disease2050-45272021-12-01941554156210.1002/iid3.508Cytomegalovirus mismatch after heart transplantation: Impact of antiviral prophylaxis and intravenous hyperimmune globulinMoritz B. Immohr0Payam Akhyari1Charlotte Böttger2Arash Mehdiani3Hannan Dalyanoglu4Ralf Westenfeld5Daniel Oehler6Igor Tudorache7Hug Aubin8Artur Lichtenberg9Udo Boeken10Department of Cardiac Surgery Heinrich Heine University Düsseldorf Düsseldorf GermanyDepartment of Cardiac Surgery Heinrich Heine University Düsseldorf Düsseldorf GermanyDepartment of Cardiac Surgery Heinrich Heine University Düsseldorf Düsseldorf GermanyDepartment of Cardiac Surgery Heinrich Heine University Düsseldorf Düsseldorf GermanyDepartment of Cardiac Surgery Heinrich Heine University Düsseldorf Düsseldorf GermanyDepartment of Cardiology Heinrich Heine University Düsseldorf Düsseldorf GermanyDepartment of Cardiology Heinrich Heine University Düsseldorf Düsseldorf GermanyDepartment of Cardiac Surgery Heinrich Heine University Düsseldorf Düsseldorf GermanyDepartment of Cardiac Surgery Heinrich Heine University Düsseldorf Düsseldorf GermanyDepartment of Cardiac Surgery Heinrich Heine University Düsseldorf Düsseldorf GermanyDepartment of Cardiac Surgery Heinrich Heine University Düsseldorf Düsseldorf GermanyAbstract 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.https://doi.org/10.1002/iid3.508CMV‐DNAemiacytomegalovirusganciclovirheart transplantationintravenous hyperimmune globulinvalganciclovir |
| spellingShingle | 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 Immunity, Inflammation and Disease CMV‐DNAemia cytomegalovirus ganciclovir heart transplantation intravenous hyperimmune globulin valganciclovir |
| title | 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_short | 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 |
| topic | CMV‐DNAemia cytomegalovirus ganciclovir heart transplantation intravenous hyperimmune globulin valganciclovir |
| url | https://doi.org/10.1002/iid3.508 |
| work_keys_str_mv | AT moritzbimmohr cytomegalovirusmismatchafterhearttransplantationimpactofantiviralprophylaxisandintravenoushyperimmuneglobulin AT payamakhyari cytomegalovirusmismatchafterhearttransplantationimpactofantiviralprophylaxisandintravenoushyperimmuneglobulin AT charlottebottger cytomegalovirusmismatchafterhearttransplantationimpactofantiviralprophylaxisandintravenoushyperimmuneglobulin AT arashmehdiani cytomegalovirusmismatchafterhearttransplantationimpactofantiviralprophylaxisandintravenoushyperimmuneglobulin AT hannandalyanoglu cytomegalovirusmismatchafterhearttransplantationimpactofantiviralprophylaxisandintravenoushyperimmuneglobulin AT ralfwestenfeld cytomegalovirusmismatchafterhearttransplantationimpactofantiviralprophylaxisandintravenoushyperimmuneglobulin AT danieloehler cytomegalovirusmismatchafterhearttransplantationimpactofantiviralprophylaxisandintravenoushyperimmuneglobulin AT igortudorache cytomegalovirusmismatchafterhearttransplantationimpactofantiviralprophylaxisandintravenoushyperimmuneglobulin AT hugaubin cytomegalovirusmismatchafterhearttransplantationimpactofantiviralprophylaxisandintravenoushyperimmuneglobulin AT arturlichtenberg cytomegalovirusmismatchafterhearttransplantationimpactofantiviralprophylaxisandintravenoushyperimmuneglobulin AT udoboeken cytomegalovirusmismatchafterhearttransplantationimpactofantiviralprophylaxisandintravenoushyperimmuneglobulin |