Postlung transplant survival is equivalent regardless of cytomegalovirus match status.
BACKGROUND
The purpose of this study was to assess (1) the relationship between donor-recipient cytomegalovirus (CMV) serologic status and posttransplant survival in the current era and (2) temporal changes in posttransplant survival by CMV matching status.


METHODS
De-identified data were obtained from the United Network for Organ Sharing. Based on pretransplant CMV serologic status (+ or -) of recipients (R) and donors (D), posttransplant survival was compared among three groups: D+ /R-, D+/- /R+, and D- /R-. Primary analysis focused on transplants performed January 1, 2000 to December 31, 2004, in recipients 18 years of age or older. To assess temporal trends in survival among groups, all lung transplants occurring between January 1, 1990, and December 31, 2004, were considered and divided into three periods based on transplant year: 1990 through 1994, 1995 through 1999, and 2000 through 2004. The primary outcome measure was survival, reported as rate of death per 100 patient-years. Kaplan-Meier analysis with log-rank test was used for time-to-event analysis.


RESULTS
During the current era (2000 through 2004), D+ /R- (n = 951), D+/- /R+ (n = 2,676), and D- /R- (n = 772) exhibited no differences in survival (p = 0.561), with rates of death per 100 patient-years of 16.6 (95% confidence interval, 14.9 to 18.5), 15.0 (95% confidence interval, 14.0 to 16.0), and 14.7 (95% confidence interval, 13.0 to 16.6), respectively. However, survival was significantly different for groups in the earlier eras of 1990 through 1994 (p < 0.001) and 1995 through 1999 (p < 0.001). During the three periods, survival improved significantly in D+ /R- (p < 0.001) and D+/- /R+ (p < 0.001), but survival in D- /R- (p = 0.351) did not change significantly with time.


CONCLUSIONS
In the current era, survival after lung transplantation is statistically equivalent regardless of CMV match status. Although in previous eras survival was worse among the D+/- /R+ and D+ /R- groups, in this era of aggressive CMV prophylaxis, CMV mismatch should not be sufficient grounds to decline a lung allograft offer.
Russo
Mark J
MJ
Lung Transplant Program and International Center for Health Outcomes and Innovation Research, Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
Sternberg
David I
DI
Hong
Kimberly N
KN
Sorabella
Robert A
RA
Moskowitz
Alan J
AJ
Gelijns
Annetine C
AC
Wilt
Jessie R
JR
D'Ovidio
Frank
F
Kawut
Steve M
SM
Arcasoy
Selim M
SM
Sonett
Joshua R
JR
D015331:Cohort Studies; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016040:Lung Transplantation / Q000379:methods / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D014019:Tissue Donors; D009927:Tissue and Organ Procurement