2695. Lung Transplant Recipients With High Risk Cytomegalovirus Mismatch Donors Managed Using A Multimodality Regimen: A Five-Year Study

Abstract Background Lung transplant (LT) recipients with high risk cytomegalovirus (CMV) mismatched donors (recipient negative, donor positive or R-/D+) have been found to have worse early and late outcomes. In our institution, high risk CMV mismatch patients are managed in a protocolized manner consisting of proactive utilization of antiviral agents (ganciclovir/valganciclovir) and immune augmentation with CMV immune globulin. Methods We reviewed our institutional LT database. The study group consistent of all patients who underwent single or bilateral lung transplant between January 2012 to December 2016 (n=319). The CMV serostatus of both recipients and donors was reviewed and patients were classified into two groups: High risk CMV mismatch (R-/D+): n=82 (25.7%) and non-high risk CMV mismatch (n=237). We compared patient demographics, co-morbidities, pre and port-transplant variables among the two groups. Three-year survival was analyzed as the primary outcome variable. With three-year survival as the dependent variable, we analyzed the association of CMV status with survival using multivariate logistic regression analysis. Results There was no difference in the baseline and post-transplant characteristics of LT recipients with and without CMV mismatch donors. Overall one-year and three-year survival was 89.96% and 72.7% respectively. Recipients transplanted with CMV mismatch status and managed with a proactive CMV prophylaxis protocol experienced similar one one-year (92.7% vs 89%, p=0.4) and three-year survival (73.2% vs 72.6%, p=1.0) as the non-CMV mismatch recipients. After adjustment for demographics, comorbidities and post-transplant course, CMV mismatch was not associated with three-year survival. Post-LT development of AKI the only independent variable to be independently associated with three-year survival (adjusted OR: 2.1, 1.13-3.87; p=0.019). Kaplan Meier analysis (see Fig) showed very similar survival curves for recipients with and without CMV mismatched donors. Conclusion Use of a proactive multimodality CMV prophylactic regimen consistent of antiviral agents (ganciclovir/valganciclovir) and immune augmentation with CMV immune globulin may improve outcomes among high risk CMV mismatch LT recipients. Disclosures All Authors: No reported disclosures