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Inicio Medicina Clínica (English Edition) Incidence, risk factors and prognostic impact of cytomegalovirus infection after...
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Vol. 154. Issue 10.
Pages 381-387 (May 2020)
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Vol. 154. Issue 10.
Pages 381-387 (May 2020)
Original article
Incidence, risk factors and prognostic impact of cytomegalovirus infection after heart transplantation
Incidencia, factores de riesgo e impacto pronóstico de la infección por citomegalovirus tras el trasplante cardiaco
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Elizabet Méndez-Eirína,b,
Corresponding author
Elizabet.Mendez.Eirin@sergas.es

Corresponding author.
, Eduardo Barge-Caballeroa,b, María Jesús Paniagua-Martína,b, Gonzalo Barge-Caballeroa,b, David Couto-Mallóna,b, Zulaika Grille-Cancelaa,b, Paula Blanco-Canosaa,b, Angelina Cañizares-Castellanosc, Miguel González Barbeitod, Ana Vanesa Aller Fernándeze, José Manuel Vázquez-Rodrígueza,b, María Generosa Crespo-Leiroa,b
a Servicio de Cardiología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
b Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
c Servicio de Microbiología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
d Servicio de Cirugía Cardiaca, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
e Servicio de Medicina Intensiva, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
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Figures (2)
Tables (4)
Table 1. Baseline clinical characteristics of the study patients.
Table 2. Incidence rate of CMV infection after transplantation.
Table 3. Univariate and multivariate analysis of risk factors for CMV infection after cardiac transplantation.
Table 4. Summary of study events.
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Abstract
Introduction and objectives

To assess the risk factors of CMV infection after heart transplant (HT) and its influence on long-term prognosis.

Methods

We conducted a retrospective single-centre study of 222 H T recipients. Risk factors for CMV infection were identified by means of multivariable Cox´s regression. Kaplan-Meier analysis and Cox´s regression were used to assess the long-term prognostic impact of CMV infection during the first post-transplant year.

Results

Donor-recipient CMV serologic matching (hazard ratio [HR] 1.92, 95% confidence interval [95% CI] 1.2–3.09, p = .007), recipient age (HR 1.02, 95% CI 1.00–1.1, p = .02), diabetes mellitus (HR 1.86, 95% CI 1.4–3.05, p = .01), pre- transplant circulatory support (HR 1.59, 95% CI 1.06–2.38, p = .03) and the use of tacrolimus (HR 1.64, 95% CI 1.13–2.36, p = .009) were independently associated with increased risk of CMV infection. CMV infection during the first year post-HT was not associated with worse transplant outcomes in terms of mortality, incidence of heart failure, cardiac allograft vasculopathy or acute rejection.

Conclusions

CMV infection was not associated with impaired long-term prognosis after HT.

Keywords:
Heart transplant
Cytomegalovirus
Outcomes
Survival.
Resumen
Introducción y objetivos

Analizar el impacto pronóstico de la infección por Citomegalovirus (CMV) durante el primer año tras el trasplante cardiaco (TC) y describir factores de riesgo.

Métodos

Se realizó un estudio retrospectivo unicéntrico incluyendo 222 receptores de TC. La identificación de factores de riesgo de infección por CMV se llevó a cabo mediante regresión multivariable de Cox. Mediante los métodos de Kaplan-Meier y Cox se analizó la influencia de la infección por CMV durante el primer año sobre la supervivencia e incidencia de eventos clínicos adversos en el seguimiento a largo plazo.

Resultados

En el análisis multivariante, el estado serológico donante/receptor frente a CMV (hazard ratio [HR] 1,92, intervalo de confianza 95% [IC 95%] 1,2–3,09; p = 0007, la edad del receptor HR 1,02, IC 95% 1,00–1,1; p = 0,02), la diabetes (HR 1,86, IC 95% 1,4-3,05; p = 0,01), el soporte circulatorio mecánico (HR 1,59, IC 95% 1,06-2,38; p = 0,03) y el uso de tacrolimus (HR 1,64, IC 95% 1,13-2,36; p = 0009, resultaron predictores independientes de infección por CMV post-trasplante. No se detectó una influencia significativa de la infección por CMV durante el primer año post-trasplante sobre la mortalidad, la incidencia de insuficiencia cardiaca, enfermedad vascular del injerto o rechazo agudo.

Conclusiones

La infección por CMV durante el primer año post-trasplante no se asoció a un peor pronóstico a largo plazo.

Palabras clave:
Trasplante cardiaco
Citomegalovirus
Pronóstico
Supervivencia

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