Authors' Reply : Transplantation

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Authors' Reply

Imlay, Hannah MD, MS1; Limaye, Ajit P.2

Author Information

1 Division of Infectious Diseases, Department of Internal Medicine, University of Utah, Salt Lake City, UT.

2 Division of Allergy and Infectious Diseases, Department of Internal Medicine, University of Washington, Seattle, WA.

Received 5 November 2022.

Accepted 10 November 2022.

This work was supported in part by National Institute of Health’s Institute of Allergy and Infectious Diseases (AI163090 to A.P.L.).

A.P.L. has received consulting fees, research support, contracted research, or consulting fees from Amplyx Pharmaceuticals, Novartis, Merck, J&J, NovoNordisc, GSK, NobelPharma, Hologic, and Allovir. H.I. declares no conflicts of interest.

Correspondence: Hannah Imlay, MD, MS, Division of Infectious Diseases, Department of Internal Medicine, University of Utah, Salt Lake City, UT. ([email protected]).

Transplantation 107(3):p e83, March 2023. | DOI: 10.1097/TP.0000000000004484
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We thank Dr Mossad et al for the comments on our manuscript.1 We described an increasing trend in the proportion of organ transplants that were Cytomegalovirus donor seropositive/recipient seronegative (D+R−) occurring between 2000 and 2020, which resulted from an increase in the proportion of R− rather than an increase in the proportion of D+.

In our data, age, race, United States citizenship, and gender were strongly associated with Cytomegalovirus serostatus in both donors and recipients. Because the increase in the proportion of D+R− transplants was more closely associated with an increase in R− rather than D+, we examined trends in recipient age, race, gender, and United States citizenship from 2000 to 2020 (supplemental data of original manuscript, Table 1).

TABLE 1. - Observed trends in recipient age, race, gender, and US citizenship in organ transplants occurring between 2000 and 2020
Trend and predicted effect in kidney recipients Trend and predicted effect in liver recipients Trend and predicted effect in heart recipients Trend and predicted effect in lung recipients
Recipient age ≥65 Increase; consistent with lower proportion of D + R− Increase; consistent with lower proportion of D + R− Increase; consistent with lower proportion of D + R− Increase; consistent with lower proportion of D + R−
Recipient male Small increase; consistent with higher proportion of D + R− Small increase; consistent with higher proportion of D + R− Small decrease; consistent with lower proportion of D + R− Increase; consistent with higher proportion of D + R−
Recipient White race Decrease; consistent with lower proportion of D + R− Small decrease; consistent with lower proportion of D + R− Decrease; consistent with lower proportion of D + R− Decrease; consistent with lower proportion of D + R−
Recipient US citizen Decrease; consistent with lower proportion of D + R− Small decrease; consistent with lower proportion of D + R− Small decrease; consistent with lower proportion of D + R− Decrease; consistent with lower proportion of D + R−

Although Dr Mossad et al propose changes in demographic characteristics that could theoretically explain an increasing proportion of D+R− transplants conducted, changes in these demographic characteristics that occurred from 2000 to 2020 did not consistently correspond with a predicted increase in proportion of R− transplant candidates.

Additional research of factors that underlie the increase in Cytomegalovirus D+R− organ transplants is warranted.

REFERENCES

1. Imlay H, Wagener MM, Vutien P, et al. Increasing proportion of high-risk cytomegalovirus donor-positive/recipient-negative serostatus in solid organ transplant recipients. Transplantation. 2022. doi:10.1097/TP.0000000000004352
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