Stress Cardiomyopathy in Donor Hearts Does Not Affect the Outcome after Heart Transplantation (original) (raw)

2016, The Journal of Heart and Lung Transplantation

Purpose: Cytomegalovirus (CMV) infection has been implicated in a number of complications after heart transplant. Our study aim was to determine the effects of CMV donor-recipient status in a large cohort of patients undergoing heart transplant. Methods: All adult heart transplants from 2000 to 2012 were identified using the United Network for Organ Sharing (UNOS) database. Patients were grouped accordingly to donor and recipient CMV status: Donor+/Recipient+ (D+/R+), Donor+/Recipient-(D+/R-), Donor-/Recipient-(D-/R-) and Donor-/Recipient+ (D-/R+). We further analyzed HLA mismatch and outcomes in these four groups. Kaplan-Meir survival curves were analyzed for 10-year survival. Cox proportional hazard models were performed to determine predictors of mortality. P-values< 0.05 were considered significant. Results: A total of 20,783 patients receiving a heart transplant were analyzed, 75% were male, 72% Caucasian and 42% had ischemic cardiomyopathy. Of the total cohort, 7,963 (38%) were D+/R+, 4,839 (24%) D+/R-, 4,847 (23%) D-/R+ and 3,134 (15%) D-/R-. Ten year censored survival estimates differed significantly (p< 0.05) between all donor/recipient CMV status groups with the exception of D+/R+ vs. D+/R-(p= 0.372) and D-/ R+ vs. D-/R-(p= 0.062; figure A). When compared to D-/R-patients, the group with the greatest hazard for mortality was the D+/R+ (HR= 1.24 95%CI:1.1-1.3; p-value< 0.01) followed by the D+/R-(HR= 1.20 95%CI: 1.1-1.3; p-value< 0.01). In the D+/R+ group the presence of ≥ 5 HLA mismatches further increased mortality while it had no effect on the other groups (p-value< 0.01, figure B). Conclusion: Our analysis has demonstrated that in a large cohort of patients, CMV positive donor status is associated with worse outcomes, independent of CMV status of the recipient. In those with CMV D+/R+ status having a ≥ 5 HLA mismatches significantly increases mortality.