Among solid organ transplant recipients, donor CMV seropositive (D+), recipient seronegative (R-) status is associated with an increased risk of graft loss and mortality after kidney or lung transplant. Whether a similar relationship exists among liver transplant recipients (LTxR) is unknown.
We assessed graft loss and mortality among adult LTxRs from 1/1/2010 to 3/14/2020 in the Organ Procurement and Transplantation Network (OPTN) database. We used multivariable mixed Cox proportional hazards regression to analyze the association of donor and recipient CMV serostatus group with graft loss and mortality, with D-R- as the reference group.
Among 54,078 LTxRs, the proportion of D-R-, D-R+, D+R-, and D+R+ was 13.4%, 22.5%, 22%, and 42%, respectively. By unadjusted Kaplan Meier survival estimates, survival by the end of follow-up was 73.3%, 73.5%, 70.1%, and 69.7%, among D-R-, D-R+, D+R-, and D+R+, respectively. By multivariable Cox regression, CMV D+R- serogroup, but not other serogroups, was independently associated with increased risk of graft loss (adjusted HR [aHR] 1.13, 95% CI 1.05-1.22) and mortality (aHR 1.13, 95% CI 1.05 – 1.22). The magnitude of the association of CMV D+R- serostatus group with mortality was similar when the Cox regression analysis was restricted to the first year post-transplant and beyond the first year post-transplant: aHR 1.13 (95% CI 1.01 – 1.27) and aHR 1.13 (95% CI 1.02 – 1.25), respectively.
Even in an era of CMV preventive strategies, CMV D+R- serogroup status remains independently associated with increased graft loss and mortality in adult LTxR. Factors in addition to direct CMV-associated short-term mortality are likely, and studies to define the underlying mechanism(s) are warranted.

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