Twelve-Month Clinical and Cost Outcomes of Removal of Cytomegalovirus Intravenous Immune Globulin From Heart Transplantation Protocol

Introduction

Cytomegalovirus (CMV) is a common opportunistic infection in solid organ transplant patients. Intravenous CMV immunoglobulin (CMV-IVIG) is a pharmacotherapy option with limited data within heart transplantation. At UCHealth, CMV-IVIG was removed from the heart transplant CMV prophylaxis protocol in July 2022. This study evaluated the efficacy and cost outcomes of CMV-IVIG removal from the protocol.

Methods

This was a single-center, retrospective cohort study of heart transplant recipients transplanted at UCHealth between October 2020 and March 2023. Patients were included if seronegative for CMV, and excluded if they died or were lost to follow-up within 12 months of transplantation. Patients included were compared after being separated into pre- and post-protocol cohorts if transplanted prior to July 1, 2022 when CMV-IVIG was removed from the protocol and afterward, respectively. Standard universal prophylaxis with valganciclovir was used in both cohorts. The primary outcome was CMV DNAemia within 12 months of heart transplant, and secondary outcomes included cost avoidance and CMV DNAemia within 18 months.

Results

Forty-two patients were included in this study. There was no significant difference in CMV DNAemia between pre- and post-protocol groups at 12 months (9.5% vs. 4.8%, p = 0.55) or 18 months (28.6% vs. 19%, p = 0.53). Median cost avoidance for removing CMV-IVIG from the protocol per patient was $30 652.13–$40 331.75.

Conclusion

Removing CMV-IVIG from a heart transplant protocol was associated with cost avoidance without worsened outcomes in CMV DNAemia. CMV-IVIG likely does not have significant benefits for preventing CMV DNAemia with concomitant universal antiviral prophylaxis in heart transplant recipients.