DOI: 10.1111/ctr.15287 ISSN: 0902-0063

The impact of active cytomegalovirus infection on donor‐derived cell‐free DNA testing in heart transplant recipients

Amit H. Alam, Johanna Van Zyl, Hira I. Shakoor, Dana Farsakh, Ahmad B. Abdelrehim, Neville Maliakkal, Aayla K. Jamil, Raksha Patel, Joost Felius, Staci McKean, Shelley A. Hall
  • Transplantation



Little is known about the relationship between cytomegalovirus (CMV) infections and donor‐derived cell‐free DNA (dd‐cfDNA) in heart transplant recipients.


In our study, CMV and dd‐cfDNA results were prospectively collected on single‐organ heart transplant recipients. If the CMV study was positive, a CMV study with dd‐cfDNA was repeated 1‐3 months later. The primary aim was to compare dd‐cfDNA between patients with positive and negative CMV results.


Of 44 patients enrolled between August 2022 and April 2023, 12 tested positive for CMV infections, 25 were included as controls, and seven patients with a viral infection without CMV were excluded. Baseline characteristics did not differ significantly between CMV‐positive and CMV‐negative patients with the exception of a later median time post‐transplant in the CMV‐positive group (253 days vs. 120 days, p = .03). Dd‐cfDNA levels were significantly higher in patients with CMV infections compared to those without (p < .001) with more patients in the CMV positive group showing dd‐cfDNA results ≥.12% (75% vs. 8%, p < .001) and ≥.20% (58% vs. 8%, p = .002). Each 1 log10 copy/ml reduction in CMV viral load from visit 1 to visit 2 was associated with a.23% reduction in log10 dd‐cfDNA (p = .002).


Our findings suggest that active CMV infections may raise dd‐cfDNA levels in patients following heart transplantation. Larger studies are needed to validate these preliminary findings.

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