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

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.