Impact of recipient age on mortality among Cytomegalovirus (CMV)-seronegative lung transplant recipients with CMV-seropositive donors.

Belga, S ; Hussain, S ; et al.

In: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, Jg. 43 (2024-04-01), Heft 4, S. 615-625

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Background: Cytomegalovirus (CMV)-seronegative lung transplant recipients (LTRs) with seropositive donors (CMV D+/R-) have the highest mortality of all CMV serostatuses. Due to immunosenescence and other factors, we hypothesized CMV D+/R- status might disproportionately impact older LTRs. Thus, we investigated whether recipient age modified the relationship between donor CMV status and mortality among CMV-seronegative LTRs.

Methods: Adult, CMV-seronegative first-time lung-only recipients were identified through the Scientific Registry of Transplant Recipients between May 2005 and December 2019. We used adjusted multivariable Cox regression to assess the relationship of donor CMV status and death. Interaction between recipient age and donor CMV was assessed via likelihood ratio testing of nested Cox models and by the relative excess risk due to interaction (RERI) and attributable proportion (AP) of joint effects.

Results: We identified 11,136 CMV-seronegative LTRs. The median age was 59 years; 65.2% were male, with leading transplant indication of idiopathic pulmonary fibrosis (35.6%); and 60.8% were CMV D+/R-. In multivariable modeling, CMV D+/R- status was associated with 27% increased hazard of death (adjusted hazard ratio: 1.27, 95% confidence interval: 1.21-1.34) compared to CMV D-/R-. Recipient age ≥60 years significantly modified the relationship between donor CMV-seropositive status and mortality on the additive scale, including RERI 0.24 and AP 11.4% (p = 0.001), that is, the interaction increased hazard of death by 0.24 and explained 11.4% of mortality in older CMV D+ recipients.

Conclusions: Among CMV-seronegative LTRs, donor CMV-seropositive status confers higher risk of posttransplant mortality, which is amplified in older recipients. Future studies should define optimal strategies for CMV prevention and management in older D+/R- LTRs.

Titel:	Impact of recipient age on mortality among Cytomegalovirus (CMV)-seronegative lung transplant recipients with CMV-seropositive donors.
Autor/in / Beteiligte Person:	Belga, S ; Hussain, S ; Avery, RK ; Nauroz, Z ; Durand, CM ; King, EA ; Massie, A ; Segev, DL ; Connor, AE ; Bush, EL ; Levy, RD ; Shah, P ; Werbel, WA
Zeitschrift:	The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation, Jg. 43 (2024-04-01), Heft 4, S. 615-625
Veröffentlichung:	1999- : New York, NY : Elsevier ; <i>Original Publication</i>: St. Louis, Mo. : Mosby-Year Book, Inc., c1991-, 2024
Medientyp:	academicJournal
ISSN:	1557-3117 (electronic)
DOI:	10.1016/j.healun.2023.11.017
Schlagwort:	Adult Humans Male Aged Middle Aged Female Transplant Recipients Tissue Donors Lung Antiviral Agents therapeutic use Retrospective Studies Cytomegalovirus Cytomegalovirus Infections drug therapy
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article Language: English [J Heart Lung Transplant] 2024 Apr; Vol. 43 (4), pp. 615-625. <i>Date of Electronic Publication: </i>2023 Dec 06. MeSH Terms: Cytomegalovirus* ; Cytomegalovirus Infections* / drug therapy ; Adult ; Humans ; Male ; Aged ; Middle Aged ; Female ; Transplant Recipients ; Tissue Donors ; Lung ; Antiviral Agents / therapeutic use ; Retrospective Studies Contributed Indexing: Keywords: CMV; effect modification; lung transplant; mortality; older age Substance Nomenclature: 0 (Antiviral Agents) Entry Date(s): Date Created: 20231207 Date Completed: 20240318 Latest Revision: 20240318 Update Code: 20240318

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