Incidence of post-transplant cytomegalovirus viremia in patients receiving lungs after ex vivo lung perfusionCentral MessagePerspective
Rafaela V.P. Ribeiro, MD, PhD,
Anas Samman, BSc,
Aizhou Wang, PhD,
Stella Wang, BSc, MSc,
Tereza Martinu, MD, MHS,
Shaf Keshavjee, MSc, MD,
Lianne G. Singer, MD,
Deepali Kumar, MSc, MD,
Atul Humar, MSc, MD,
Marcelo Cypel, MSc, MD
Affiliations
Rafaela V.P. Ribeiro, MD, PhD
Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
Anas Samman, BSc
Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
Aizhou Wang, PhD
Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
Stella Wang, BSc, MSc
Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
Tereza Martinu, MD, MHS
Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Toronto Lung Transplant Program, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
Shaf Keshavjee, MSc, MD
Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Toronto Lung Transplant Program, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
Lianne G. Singer, MD
Toronto Lung Transplant Program, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
Deepali Kumar, MSc, MD
Toronto Lung Transplant Program, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
Atul Humar, MSc, MD
Toronto Lung Transplant Program, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
Marcelo Cypel, MSc, MD
Latner Thoracic Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Toronto Lung Transplant Program, Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Address for reprints: Marcelo Cypel, MSc, MD, Division of Thoracic Surgery, Toronto General Hospital, 200 Elizabeth St, 9N969, Toronto, Ontario, M5G 2C4, Canada.
Objectives: Cytomegalovirus infection after lung transplant is associated with increased morbidity and mortality. Inflammation, infection, and longer ischemic times are important risk factors for cytomegalovirus infection. Ex vivo lung perfusion has helped to successfully increase the use of high-risk donors over the last decade. However, the impact of ex vivo lung perfusion on post-transplant cytomegalovirus infection is unknown. Methods: We performed a retrospective analysis of all adult lung transplant recipients from 2010 to 2020. The primary end point was comparison of cytomegalovirus viremia between patients who received ex vivo lung perfusion donor lungs and patients who received non–ex vivo lung perfusion donor lungs. Cytomegalovirus viremia was defined as cytomegalovirus viral load greater than 1000 IU/mL within 2 years post-transplant. Secondary end points were the time from lung transplant to cytomegalovirus viremia, peak cytomegalovirus viral load, and survival. Outcomes were also compared between the different donor recipient cytomegalovirus serostatus matching groups. Results: Included were 902 recipients of non–ex vivo lung perfusion lungs and 403 recipients of ex vivo lung perfusion lungs. There was no significant difference in the distribution of the cytomegalovirus serostatus matching groups. A total of 34.6% of patients in the non–ex vivo lung perfusion group developed cytomegalovirus viremia, as did 30.8% in the ex vivo lung perfusion group (P = .17). There was no difference in time to viremia, peak viral loads, or survival when comparing both groups. Likewise, all outcomes were comparable in the non–ex vivo lung perfusion and ex vivo lung perfusion groups within each serostatus matching group. Conclusions: The practice of using more injured donor organs via ex vivo lung perfusion has not affected cytomegalovirus viremia rates and severity in lung transplant recipients in our center.
