title: Incidence, risk factors, and outcomes of delayed-onset cytomegalovirus disease in a large, retrospective cohort of heart transplant recipients.
abstract: BACKGROUND
  Delayed-onset cytomegalovirus (CMV) disease can occur among heart transplant recipients after stopping anti-CMV prophylaxis. We evaluated a large, retrospective cohort of heart transplant recipients in the United States through the use of billing data from 3 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) to determine the epidemiology of delayed-onset CMV disease coded during hospital readmission.
  
  
  METHODS
  We identified 2280 adult heart transplant recipients from 2004 to 2010 through the use of the California, Florida, and New York SID. Demographics, comorbidities, heart failure etiology, CMV disease, and inpatient death were identified. CMV disease was classified as early-onset (≤100 days) or delayed-onset (>100 days after transplant). Possible tissue invasion by CMV was determined through the use of codes for CMV pneumonitis, hepatitis, and gastrointestinal endoscopy. Multivariate analysis was performed with the use of Cox proportional hazards models.
  
  
  RESULTS
  Delayed-onset CMV disease occurred in 7.5% (170/2280) and early-onset CMV disease occurred in 2.0% (45/2280) of heart transplant recipients. Risk factors for delayed-onset CMV disease included residence in a non-metropolitan locale (aHR. 1.8; 95% confidence interval [CI], 1.0-3.3) and ischemic cardiomyopathy as heart failure etiology (aHR, 1.8; 95% CI, 1.3-2.5). Inpatient death >100 days after transplant was associated with delayed-onset CMV disease with possible tissue invasion (aHR, 2.0; 95% CI, 1.1-3.8), transplant failure or rejection (aHR, 4.0; 95% CI, 2.7-5.8), and renal failure (aHR, 1.5; 95% CI, 1.1-2.0).
  
  
  CONCLUSIONS
  Delayed-onset CMV disease is more common than early-onset CMV disease among heart transplant recipients. These results suggest that delayed-onset tissue-invasive CMV disease may be associated with an increased risk of death.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri. Electronic address: csantos@dom.wustl.edu.
authors.forename: C A Q
authors.initials: CA
authors.lastname: Santos
authors.affiliation: Division of Renal Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri.
authors.forename: D C
authors.initials: DC
authors.lastname: Brennan
authors.affiliation: Department of Medicine, Washington University School of Medicine, St Louis, Missouri.
authors.forename: V J
authors.initials: VJ
authors.lastname: Fraser
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St Louis, Missouri; Division of Public Health Sciences and the Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
authors.forename: M A
authors.initials: MA
authors.lastname: Olsen
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000453:epidemiology*; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D066027:Transplant Recipients; D014481:United States / Q000453:epidemiology