P-1797. The Effect of Recipient Age and Cytomegalovirus Sero-status on Patient and Graft Survival in Liver Transplant Recipients

TL;DR

This study finds that liver transplant recipients aged 40-60 with CMV seropositivity face the worst survival outcomes, highlighting the need for targeted strategies in this age group.

Contribution

The study identifies a specific age group (40-60 years) with heightened risk of poor outcomes due to CMV seropositivity after liver transplantation.

Findings

CMV seropositive liver transplant recipients have significantly worse overall and graft survival compared to CMV D-/R- recipients.

The negative impact of CMV seropositivity on survival is most pronounced in recipients aged 40-60 years.

Effective CMV prophylaxis is not sufficient to mitigate the risk in the 40-60-year-old age group.

Abstract

Cytomegalovirus (CMV) may impact allograft function and overall survival in solid organ transplant recipients in various direct or indirect mechanisms. The association between recipient age and donor-recipient CMV status and outcomes of liver transplantation (LT) are unclear.

Retrospective analysis of the Scientific Registry of Transplant Recipients for LT recipients ≥18 years old between 2000-2020 (N=89,753) was conducted. Recipient age-based stratification analysis was performed to compare the association of CMV serostatus and recipient age on overall and graft survival after LT. Survival curves were generated using the Kaplan-Meier method. All-cause mortality and graft failure hazard ratios were calculated at one- and five-years post-LT.

LT recipients were stratified in to age groups (years) of ≥ 60 (36,636; 40.8%), 40-60 (43,921; 48.9%), and < 40 (9,196; 10.3%). Among these LT recipients, various CMV serostatus groups were D-R- (12,521;13.8%), D+R- (20,815; 23.0%), D-R+ (19.830; 21.9%), and D+R+ (37,395; 41.3%). In the age-based stratification analysis, all CMV seropositive statuses (D+R-, D-R+, D+R+) when compared to CMV D-/R-, were negatively associated with overall and graft survival at both one- and five-years post-LT (p< 0.0001), group. The negative association of CMV seropositivity on one-year and five-year overall and graft survival was most pronounced in 40-60 years group (Fig 1, 2) when compared to the other two age groups.

During the current era of effective CMV prophylaxis, LT recipients in the 40-60-year age group are at the highest risk of CMV seropositivity (D+R-, D-R+, D+R+) associated worse overall and graft survival at both one- and five-years post-LT. Identification of age-based risk factors, increased awareness, as well as effective diagnostic and therapeutic strategies are needed to mitigate this risk.

Abhay Dhand, MD, Eurofins Viracor: Advisor/Consultant|Eurofins Viracor: Honoraria|Merck: Advisor/Consultant|Merck: Honoraria

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