Risk Factors and Outcomes of Recurrent Cytomegalovirus Infection in Heart Transplant Recipients
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Wiley
2025
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| author | Vaisak O. Nair Zachary A. Yetmar Bismarck S. Bisono‐Garcia Lisa Brumble Holenarasipur R. Vikram Raymund R. Razonable Elena Beam |
| author_facet | Vaisak O. Nair Zachary A. Yetmar Bismarck S. Bisono‐Garcia Lisa Brumble Holenarasipur R. Vikram Raymund R. Razonable Elena Beam Vaisak O. Nair Zachary A. Yetmar Bismarck S. Bisono‐Garcia Lisa Brumble Holenarasipur R. Vikram Raymund R. Razonable Elena Beam |
| collection | Wiley Open Access |
| contents | Risk Factors and Outcomes of Recurrent Cytomegalovirus Infection in Heart Transplant Recipients Vaisak O. Nair Zachary A. Yetmar Bismarck S. Bisono‐Garcia Lisa Brumble Holenarasipur R. Vikram Raymund R. Razonable Elena Beam Clinical Transplantation ABSTRACT Purpose The purpose of this study was to evaluate the incidence and risk factors for developing recurrent clinically significant cytomegalovirus infections (csCMVi) in heart transplant recipients. Methods We conducted a retrospective cohort study involving adult heart transplant recipients at three large transplant centers in the United States between January 2011 and March 2019. All patients with a history of csCMVi, defined as CMV disease or CMV infection requiring preemptive therapy, were followed from the date of treatment completion for the primary csCMVi episode. Outcomes of interest were recurrent csCMVi and all‐cause mortality. Results Among 98 heart transplant recipients with csCMVi, 22 (22.4%) episodes of recurrent csCMVi occurred. Median time‐to‐recurrent csCMVi was 31.5 (IQR 21.3–59.8) days following treatment completion. A preceding episode of CMV disease (versus infection) was associated with a lower risk of recurrent csCMVi (HR 0.29, 95% CI 0.08–0.98; p = 0.047). Patients with lymphopenia had higher rates of recurrent csCMVi without statistical significance (HR 2.13, 95% CI 0.88–5.13; p = 0.093). Seroconversion by the end‐of‐therapy among CMV D+/R− mismatched patients was associated with a reduced risk of csCMVi recurrence (HR 0.07, 95% CI 0.02–0.30; p < 0.001). Overall, 17 (17.3%) patients died during follow‐up, which was not significantly higher among those with recurrent csCMVi (HR 2.13, 95% CI 0.78–5.79; p = 0.141). Conclusions About one in five heart recipients with csCMVi developed post‐treatment recurrence. A preceding episode of CMV disease and seroconversion was protective against recurrence. Lymphopenia may be a practical biomarker to stratify recurrence risk. Overall, recurrent csCMVi was not significantly associated with mortality. 10.1111/ctr.70342 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| doi_str_mv | 10.1111/ctr.70342 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_ctr_70342 |
| institution | Wiley Open Access |
| license_str_mv | http://onlinelibrary.wiley.com/termsAndConditions#vor |
| publishDate | 2025 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Risk Factors and Outcomes of Recurrent Cytomegalovirus Infection in Heart Transplant Recipients Vaisak O. Nair Zachary A. Yetmar Bismarck S. Bisono‐Garcia Lisa Brumble Holenarasipur R. Vikram Raymund R. Razonable Elena Beam Clinical Transplantation Risk Factors and Outcomes of Recurrent Cytomegalovirus Infection in Heart Transplant Recipients Vaisak O. Nair Zachary A. Yetmar Bismarck S. Bisono‐Garcia Lisa Brumble Holenarasipur R. Vikram Raymund R. Razonable Elena Beam Clinical Transplantation ABSTRACT Purpose The purpose of this study was to evaluate the incidence and risk factors for developing recurrent clinically significant cytomegalovirus infections (csCMVi) in heart transplant recipients. Methods We conducted a retrospective cohort study involving adult heart transplant recipients at three large transplant centers in the United States between January 2011 and March 2019. All patients with a history of csCMVi, defined as CMV disease or CMV infection requiring preemptive therapy, were followed from the date of treatment completion for the primary csCMVi episode. Outcomes of interest were recurrent csCMVi and all‐cause mortality. Results Among 98 heart transplant recipients with csCMVi, 22 (22.4%) episodes of recurrent csCMVi occurred. Median time‐to‐recurrent csCMVi was 31.5 (IQR 21.3–59.8) days following treatment completion. A preceding episode of CMV disease (versus infection) was associated with a lower risk of recurrent csCMVi (HR 0.29, 95% CI 0.08–0.98; p = 0.047). Patients with lymphopenia had higher rates of recurrent csCMVi without statistical significance (HR 2.13, 95% CI 0.88–5.13; p = 0.093). Seroconversion by the end‐of‐therapy among CMV D+/R− mismatched patients was associated with a reduced risk of csCMVi recurrence (HR 0.07, 95% CI 0.02–0.30; p < 0.001). Overall, 17 (17.3%) patients died during follow‐up, which was not significantly higher among those with recurrent csCMVi (HR 2.13, 95% CI 0.78–5.79; p = 0.141). Conclusions About one in five heart recipients with csCMVi developed post‐treatment recurrence. A preceding episode of CMV disease and seroconversion was protective against recurrence. Lymphopenia may be a practical biomarker to stratify recurrence risk. Overall, recurrent csCMVi was not significantly associated with mortality. 10.1111/ctr.70342 http://onlinelibrary.wiley.com/termsAndConditions#vor |
| title | Risk Factors and Outcomes of Recurrent Cytomegalovirus Infection in Heart Transplant Recipients |
| topic | Clinical Transplantation |
| url | https://onlinelibrary.wiley.com/doi/10.1111/ctr.70342 |