The Risk of Leukopenia with Universal vs. Preemptive Prophylaxis Strategies in Heart Transplant Recipients at Intermediate Risk for CMV Complications

Purpose Heart transplant recipients with prior exposure to CMV (R+) are considered intermediate risk for CMV-related complications, and current guidelines allow for either universal prophylaxis or a pre-emptive approach to prophylaxis. Some centers prefer a preemptive approach to mitigate the cost and risks of prophylaxis, most notably the risk of leukopenia. In the present study, we evaluate the risks of leukopenia with each prophylaxis approach. Methods Retrospective analysis of 440 intermediate risk (CMV R+) HTx recipients from 6 U.S. centers between 2010-2018, treated with either universal prophylaxis (73%, n = 323) or preemptive therapy (27%, n = 117). The primary endpoint was the development of leukopenia (WBC Results Of the 440 patients in the analysis, 177 (40%) developed leukopenia (WBC Conclusion Leukopenia occurs in 40% of heart transplant recipients. Although CMV prophylaxis has been associated with leukopenia, there is no difference in this risk when comparing a universal vs. preemptive prophylaxis strategy for CMV.