Effect of CMV Mismatch on Heart Transplant Outcomes Using a Surveillance and Preemptive Strategy

Purpose The aim of the study was to determine outcomes after heart transplantation for cytomegalovirus (CMV) mismatched patients (D + /R − ) who underwent a surveillance and preemptive therapy protocol, compared to nonmismatch patients. Methods A review of patient records from January 2010 to December 2020 with follow‐up to October 2023 was done. The protocol consisted weekly surveillance with CMV PCR starting 4 weeks after transplant continuing up until the patient seroconverts or up to 3 months posttransplant if the patient does not seroconvert. Valganciclovir was given for 2 weeks to those who seroconverted. Results Two hundred and twenty‐one patients were included, and 23% were mismatched patients. Overall survival was not different between CMV groups ( p = NS). Causes of death and morbidities were also not significantly different ( p = NS). Sixty‐six percent of mismatch patients seroconverted, and there was also a significantly older donor age in the seroconverted patients compared to nonseroconverted patients (41 ± 11 vs. 29 ± 12 years, p < 0.005), indicating a higher risk donor profile. A multivariate Cox regression including donor age showed that there was no increase in mortality in the seroconverted mismatches compared to nonmismatch patients ( p = NS). Conclusions There is no significant increased mortality or morbidity using a CMV surveillance and preemptive therapy protocol. The effect of donor age on seroconversion of mismatches requires further validation.