Cardiovascular Disease |

Cytomegalovirus (CMV) Infections in Heart Transplant Recipients FREE TO VIEW

Sarah Lee, MPH; Lisbeth Garcia Arguello; Raymund Razonable
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Mayo Clinic, Rochester, MN

Chest. 2014;146(4_MeetingAbstracts):126A. doi:10.1378/chest.1991796
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SESSION TITLE: Heart Failure Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: CMV infection in heart transplant (HT) patients is associated with poor allograft and patient survival [1]. Antiviral prophylaxis and preemptive therapy reduces the incidence of CMV disease, but prevention strategies vary [2, 3]. This study aims to define the epidemiology of CMV infection in the era of antiviral prophylaxis and preemptive strategy.

METHODS: This is a retrospective cohort of consecutive adults who received a HT from 1/2005 to 12/2012. CMV infection was defined as a viral load >2000 copies/mL or seroconversion. CMV donor positive/recipient negative (D+/R-) HT patients received valganciclovir prophylaxis for three months while R+ HT patients were monitored and treated preemptively.

RESULTS: The study population consisted of 199 HT (median age, 53; 32% D+/R-) patients. Median duration of prophylaxis in CMV D+/R- patients was 92 days. Asymptomatic CMV infection occurred in 22 patients (11% HT), with the median time to onset of 47 days (range 36,96) after transplantation. Primary CMV disease occurred in 25 HT patients, and presented as viral syndrome (n=14) or tissue invasive disease (n=11). Among reactivation CMV disease, 15 presented as a viral syndrome and 3 as tissue invasive disease. The median time to onset of CMV disease was 156 days (range 50,249) after transplantation. For CMV D+/R- HT recipients who received antiviral prophylaxis, four developed asymptomatic infection while 25 developed CMV disease; all cases occurred after completion of antiviral prophylaxis.

CONCLUSIONS: CMV infection and disease continue to occur in D+/R- HT patients despite antiviral prophylaxis. CMV disease also occurs in R+ patients despite CMV surveillance. CMV prevention strategies need further optimization in HT recipients.

CLINICAL IMPLICATIONS: CMV is the most important infection in transplant recipients due to wide-ranging clinical effects including mild viral syndrome, disseminated disease and organ failure, allograft rejection, and mortality. The occurrence of CMV disease despite preemptive therapy and antiviral prophylaxis suggest the need to optimize the current strategies and to explore innovative ways for CMV prevention.

DISCLOSURE: The following authors have nothing to disclose: Sarah Lee, Lisbeth Garcia Arguello, Raymund Razonable

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