Long-Term Impact of Cytomegalovirus Serologic Status on Lung Transplantation in the United States

Chitaru Kurihara, Ramiro Fernandez, Niloufar Safaeinili, Mahzad Akbarpour, Qiang Wu, GR Scott Budinger, Ankit Bharat*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background: Cytomegalovirus (CMV) infection has been associated with poor outcomes after solid organ transplantation. The long-term impact of donor and recipient CMV serological status on lung transplant outcomes remains unclear. Accordingly, we evaluated the impact of donor and recipient CMV status on long-term patients as well as allograft survival after single (SLT) and double lung transplantation (BLT). Methods: The Scientific Registry of Transplant Recipients was used to track all adult lung transplants in United States from May 2005 to June 2016. Patient mortality and bronchiolitis obliterans syndrome were determined up to 5 years using Cox proportional hazards modeling. Additionally, landmark analysis was performed conditional on survival at 1 year. Results: Compared with donor negative–recipient CMV-IgG negative (D-R-), donor positive–recipient negative (D+R-) and donor positive–recipient positive (D+R+) groups had increased mortality at 1 and 5 years after BLT, with the former demonstrating highest risk. Although mortality was not increased with CMV seropositive donors after SLT at 1 year, both D+R- and D+R+ groups demonstrated greater mortality at 5 years. Risk of bronchiolitis obliterans syndrome was not affected by CMV serological status. Conditional landmark analysis confirmed that lungs from CMV seropositive donors conferred highest risk for long-term mortality. Conclusions: CMV seronegative recipients undergoing either BLT or SLT from CMV seropositive donors have the highest risk of long-term mortality that extends beyond the first year. Further studies are needed to determine the causes of higher mortality observed in the CMV seronegative recipients and risks and benefits of extension of CMV prophylaxis, particularly in the high-risk group.

Original languageEnglish (US)
Pages (from-to)1046-1052
Number of pages7
JournalAnnals of Thoracic Surgery
Volume107
Issue number4
DOIs
StatePublished - Apr 1 2019

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Lung Transplantation
Cytomegalovirus
Tissue Donors
Mortality
Bronchiolitis Obliterans
Lung
Transplants
Cytomegalovirus Infections
Organ Transplantation
Allografts
Registries
Immunoglobulin G
Survival

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Kurihara, Chitaru ; Fernandez, Ramiro ; Safaeinili, Niloufar ; Akbarpour, Mahzad ; Wu, Qiang ; Budinger, GR Scott ; Bharat, Ankit. / Long-Term Impact of Cytomegalovirus Serologic Status on Lung Transplantation in the United States. In: Annals of Thoracic Surgery. 2019 ; Vol. 107, No. 4. pp. 1046-1052.
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title = "Long-Term Impact of Cytomegalovirus Serologic Status on Lung Transplantation in the United States",
abstract = "Background: Cytomegalovirus (CMV) infection has been associated with poor outcomes after solid organ transplantation. The long-term impact of donor and recipient CMV serological status on lung transplant outcomes remains unclear. Accordingly, we evaluated the impact of donor and recipient CMV status on long-term patients as well as allograft survival after single (SLT) and double lung transplantation (BLT). Methods: The Scientific Registry of Transplant Recipients was used to track all adult lung transplants in United States from May 2005 to June 2016. Patient mortality and bronchiolitis obliterans syndrome were determined up to 5 years using Cox proportional hazards modeling. Additionally, landmark analysis was performed conditional on survival at 1 year. Results: Compared with donor negative–recipient CMV-IgG negative (D-R-), donor positive–recipient negative (D+R-) and donor positive–recipient positive (D+R+) groups had increased mortality at 1 and 5 years after BLT, with the former demonstrating highest risk. Although mortality was not increased with CMV seropositive donors after SLT at 1 year, both D+R- and D+R+ groups demonstrated greater mortality at 5 years. Risk of bronchiolitis obliterans syndrome was not affected by CMV serological status. Conditional landmark analysis confirmed that lungs from CMV seropositive donors conferred highest risk for long-term mortality. Conclusions: CMV seronegative recipients undergoing either BLT or SLT from CMV seropositive donors have the highest risk of long-term mortality that extends beyond the first year. Further studies are needed to determine the causes of higher mortality observed in the CMV seronegative recipients and risks and benefits of extension of CMV prophylaxis, particularly in the high-risk group.",
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Long-Term Impact of Cytomegalovirus Serologic Status on Lung Transplantation in the United States. / Kurihara, Chitaru; Fernandez, Ramiro; Safaeinili, Niloufar; Akbarpour, Mahzad; Wu, Qiang; Budinger, GR Scott; Bharat, Ankit.

In: Annals of Thoracic Surgery, Vol. 107, No. 4, 01.04.2019, p. 1046-1052.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Long-Term Impact of Cytomegalovirus Serologic Status on Lung Transplantation in the United States

AU - Kurihara, Chitaru

AU - Fernandez, Ramiro

AU - Safaeinili, Niloufar

AU - Akbarpour, Mahzad

AU - Wu, Qiang

AU - Budinger, GR Scott

AU - Bharat, Ankit

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Background: Cytomegalovirus (CMV) infection has been associated with poor outcomes after solid organ transplantation. The long-term impact of donor and recipient CMV serological status on lung transplant outcomes remains unclear. Accordingly, we evaluated the impact of donor and recipient CMV status on long-term patients as well as allograft survival after single (SLT) and double lung transplantation (BLT). Methods: The Scientific Registry of Transplant Recipients was used to track all adult lung transplants in United States from May 2005 to June 2016. Patient mortality and bronchiolitis obliterans syndrome were determined up to 5 years using Cox proportional hazards modeling. Additionally, landmark analysis was performed conditional on survival at 1 year. Results: Compared with donor negative–recipient CMV-IgG negative (D-R-), donor positive–recipient negative (D+R-) and donor positive–recipient positive (D+R+) groups had increased mortality at 1 and 5 years after BLT, with the former demonstrating highest risk. Although mortality was not increased with CMV seropositive donors after SLT at 1 year, both D+R- and D+R+ groups demonstrated greater mortality at 5 years. Risk of bronchiolitis obliterans syndrome was not affected by CMV serological status. Conditional landmark analysis confirmed that lungs from CMV seropositive donors conferred highest risk for long-term mortality. Conclusions: CMV seronegative recipients undergoing either BLT or SLT from CMV seropositive donors have the highest risk of long-term mortality that extends beyond the first year. Further studies are needed to determine the causes of higher mortality observed in the CMV seronegative recipients and risks and benefits of extension of CMV prophylaxis, particularly in the high-risk group.

AB - Background: Cytomegalovirus (CMV) infection has been associated with poor outcomes after solid organ transplantation. The long-term impact of donor and recipient CMV serological status on lung transplant outcomes remains unclear. Accordingly, we evaluated the impact of donor and recipient CMV status on long-term patients as well as allograft survival after single (SLT) and double lung transplantation (BLT). Methods: The Scientific Registry of Transplant Recipients was used to track all adult lung transplants in United States from May 2005 to June 2016. Patient mortality and bronchiolitis obliterans syndrome were determined up to 5 years using Cox proportional hazards modeling. Additionally, landmark analysis was performed conditional on survival at 1 year. Results: Compared with donor negative–recipient CMV-IgG negative (D-R-), donor positive–recipient negative (D+R-) and donor positive–recipient positive (D+R+) groups had increased mortality at 1 and 5 years after BLT, with the former demonstrating highest risk. Although mortality was not increased with CMV seropositive donors after SLT at 1 year, both D+R- and D+R+ groups demonstrated greater mortality at 5 years. Risk of bronchiolitis obliterans syndrome was not affected by CMV serological status. Conditional landmark analysis confirmed that lungs from CMV seropositive donors conferred highest risk for long-term mortality. Conclusions: CMV seronegative recipients undergoing either BLT or SLT from CMV seropositive donors have the highest risk of long-term mortality that extends beyond the first year. Further studies are needed to determine the causes of higher mortality observed in the CMV seronegative recipients and risks and benefits of extension of CMV prophylaxis, particularly in the high-risk group.

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DO - 10.1016/j.athoracsur.2018.10.034

M3 - Article

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SP - 1046

EP - 1052

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

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