No benefit from 3-month valguanciclovir prophylaxis vs preemptive treatment in heart transplantation: should we extend the prophylaxis to 200 days or beyond?

G. Le Fevere de Ten Hove, O.V.C. van Caenegem, T.H. Timmermans, A. Poncelet

Friday 16 march 2018

11:10 - 11:20h at Van Rijck/Ruys Zaal

Categories: Clinical, Session (parallel)

Parallel session: Parallel session 15: Clinical

Aim

Cytomegalovirus (CMV) is the main opportunistic pathogen in solid organ transplantation and has a major impact on outcome both by its direct and indirect effects. Both prophylactic and preemptive strategies have been described. We reviewed our 20-year experience both in term of CMV infection and in term of its potential influence of long-term complications such as acute cellular rejection and coronary artery disease.

Methods

Retrospective single-center study of heart transplants recipients from 1995 to 2015. Out of 305 patients (310 Tx), 231 met our inclusion’s criteria. All CMV seropositive recipients benefited from the preemptive strategy, as did the high-risk group (seronegative recipient/seropositive donor) from 1995 to 2004. From 2005 to 2015, the later group received 3 months anti-CMV prophylaxis. End-points of this study were CMV infection, acute rejection, cardiac allograft vasculopathy (CAV) and patient survival.

Results

32% of our patients developed CMV infection during the follow-up, the majority within the first 6 months after transplantation. Overall, 11.2% of our patients developed CMV disease (10.4% in seropositive patients vs 32.4% in high-risk patients, p=0.001). The 3-month prophylaxis significantly delayed the occurrence of CMV infection but had no beneficial effect on its incidence. CMV infection did not influence the rate of acute cellular rejection within the first year (3A or higher: 10.4%), nor on the occurrence of CAV (24 % at 10yr). The median survival time of our cohort was 15 years. CMV infection had no impact on survival, though patients with CMV disease had a non-significant decrease in survival time (9.9yrs, p=0.15).

Conclusion

Anti-CMV prophylaxis for 3 months delayed CMV infection but with a tendency to increase the incidence of CMV disease. This study could not demonstrate any pejorative effect of CMV on rejection nor on chronic allograft vasculopathy. Additional studies should be done with longer prophylaxis in heart transplant recipients since favorable data were demonstrated in other solid organ transplantation.