Cytomegalovirus Donor and Recipient Serostatus and 5‐Year Mortality After Heart Transplantation: Evidence of Racial Differences
Maheen Z. Abidi, Deena N. Brosi, Sara Belga, William A. Werbel, Adriana Weinberg, Kristine M. Erlandson, Jesse D. ScholdABSTRACT
Background
Cytomegalovirus (CMV) donor/recipient (D/R) serostatus is an established determinant of post‐transplant outcomes in heart transplantation (HT); however, the extent to which demographic and socioeconomic (SE) factors modify CMV‐related mortality risk remains unclear.
Methods
Using the scientific registry of transplant recipients, we evaluated whether demographic and SE factors alter the association between CMV D/R serostatus and 5‐year all‐cause mortality among first‐time, adult HT recipients (2010–2024). Multivariable competing risk models estimated sub‐distribution hazard ratios (sHRs) for CMV D/R serostatus interacted with age, sex, race/ethnicity, and Distressed Community Index (DCI) categories.
Results
CMV D+/R− and CMV D+/R+ serostatus were associated with increased 5‐year mortality. Effect modification varied by subgroup. Age, sex, and DCI did not significantly modify CMV‐associated mortality, suggesting consistent relative risk across these strata. In contrast, race/ethnicity significantly modified the association with attenuated mortality among Black HT recipients compared with White HT recipients (reference). The sHR for mortality comparing Black CMV D−/R− and CMV D+/R+ HT recipients was 0.69 lower (95% CI: 0.57–0.84; p ‐value < 0.001) than the corresponding estimate in White HT recipients. Similarly, the sHR comparing Black CMV D−/R− and CMV D−/R+ HT recipients was 0.78 lower (95% CI: 0.63–0.97; p ‐value = 0.024) than the White HT recipients. No significant differences were observed between White and Hispanic/Other racial/ethnic groups.
Conclusions
CMV‐related mortality risk was evident among White recipients, however, the effect of CMV on post‐transplant outcomes is attenuated in Black recipients. These findings highlight heterogeneity in CMV‐associated risk and support more individualized CMV prevention and monitoring strategies incorporating demographic context.