1551. The Impact of Recurrent CMV Disease on Long-Term Survival in Solid Organ Transplant Recipients

BACKGROUND: Cytomegalovirus (CMV) remains a significant contributor to morbidity and mortality following solid-organ transplantation (SOT). While relapse after treatment completion can occur in up to 30% of patients, the effect of this on mortality is not clear. The aim of this study was to explore the impact of recurrent CMV disease on long-term survival in SOT recipients. METHODS: We performed a retrospective cohort study of heart, liver and kidney transplant recipients who completed treatment for an episode of CMV disease. Data on potential confounders were collected from the time of CMV treatment completion. Censoring occurred at the time of death, loss to follow-up or 10 years. Univariable and multivariable hazard ratios (HR) were calculated using a Cox model, treating relapse and rejection following CMV as time-varying covariates. RESULTS: Seventy-nine kidney, 52 heart, 34 liver and five liver-kidney transplant recipients were included. Sixty-two of 170 died, at a median of 3.8 years (interquartile range [IQR] 0.8–6.6 years). Median follow-up amongst the 108 survivors was 7.4 years (IQR 3.7–10 years) although 22 (13%) were censored before 3 years. CMV relapse occurred in 49/170 (29%), 67% within 6 months of treatment completion. Overall mortality amongst those who relapsed was 39% (19/49) vs. 36% (43/121) in those who remained relapse free. On univariable analysis, CMV relapse was not associated with a significantly increased risk of death (unadjusted HR 1.59, 95% CI 0.92–2.75, P = 0.10). After controlling for age and transplanted organ type, findings were similar (adjusted HR 1.68, 95% CI 0.93–3.04, P = 0.09). CONCLUSION: Mortality rates following CMV remain high even in the valganciclovir era. In our study, we did not identify a significant relationship between the development of recurrent CMV disease and death. However, the complex nature of these patients, multiple layers of potential confounding and limited statistical power of our cohort make detection of small effects difficult. Future prospective studies evaluating the clinical efficacy of strategies to reduce recurrence are needed to further assess this relationship. DISCLOSURES: D. Snydman, Merck: Board Member, Consulting fee and Grant recipient; Shire: Board Member, Consulting fee; Takeda: Board Member, Consulting fee; Chimerix: Board Member, Consulting fee; Seres Therapeutics: Grant Investigator, Grant recipient; Actelion: Grant Investigator, Grant recipient; Moderna: Board Member, Consulting fee; Summit: Grant Investigator, Grant recipient; Tetraphase: Grant Investigator, Grant recipient.