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Ann Thorac Surg 2007;84:1129-1135
© 2007 The Society of Thoracic Surgeons

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Original Articles: General Thoracic

Postlung Transplant Survival is Equivalent Regardless of Cytomegalovirus Match Status

^a Lung Transplant Program and International Center for Health Outcomes and Innovation Research (InCHOIR), Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York
^b Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York

Accepted for publication May 11, 2007.

^_* Address correspondence to Dr Sonett, Division of Cardiothoracic Surgery, New York-Presbyterian Hospital/Columbia, PH Room 104, 14th Floor, 622 W 168th St, New York, NY 10032 (Email: js2106{at}columbia.edu).

Presented at the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31, 2007.

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.

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